Provider Demographics
NPI:1417515925
Name:GBAROYE, EBENEZER OLUSEYE
Entity Type:Individual
Prefix:
First Name:EBENEZER
Middle Name:OLUSEYE
Last Name:GBAROYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1418
Mailing Address - Country:US
Mailing Address - Phone:973-704-7942
Mailing Address - Fax:
Practice Address - Street 1:1139 E JERSEY ST STE 417
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2446
Practice Address - Country:US
Practice Address - Phone:973-704-7942
Practice Address - Fax:908-345-5184
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care