Provider Demographics
NPI:1558693135
Name:PEPRAH, EBENEZER
Entity Type:Individual
Prefix:MR
First Name:EBENEZER
Middle Name:
Last Name:PEPRAH
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 1:1850 LAFAYETTE AVE
Mailing Address - Street 2:#20G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2858
Mailing Address - Country:US
Mailing Address - Phone:347-591-0149
Mailing Address - Fax:
Practice Address - Street 1:1850 LAFAYETTE AVENUE
Practice Address - Street 2:, APT#20G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473
Practice Address - Country:US
Practice Address - Phone:347-591-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2591403181223G0001X, 146D00000X, 152WP0200X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No1223G0001XDental ProvidersDentistGeneral Practice
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program