Provider Demographics
NPI:1487010997
Name:GHEBREYESUS, ERMIAS
Entity Type:Individual
Prefix:
First Name:ERMIAS
Middle Name:
Last Name:GHEBREYESUS
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 1:408 E 92ND ST APT 10D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-8102
Mailing Address - Country:US
Mailing Address - Phone:347-738-0318
Mailing Address - Fax:
Practice Address - Street 1:408 E 92ND ST APT 10D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-8102
Practice Address - Country:US
Practice Address - Phone:347-738-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599579-1163W00000X
CA95000510367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse