Provider Demographics
NPI:1508069295
Name:EBBRECHT, ELAINE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MARIE
Last Name:EBBRECHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TULIPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5616
Mailing Address - Country:US
Mailing Address - Phone:631-670-6753
Mailing Address - Fax:
Practice Address - Street 1:1 GARRET MOUNTAIN PLZ
Practice Address - Street 2:SUITE 801
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3320
Practice Address - Country:US
Practice Address - Phone:973-345-4111
Practice Address - Fax:973-345-4119
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-010078111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor