Provider Demographics
NPI:1790124014
Name:BOTE, EBENEZER GARCIA (RN)
Entity Type:Individual
Prefix:MR
First Name:EBENEZER
Middle Name:GARCIA
Last Name:BOTE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1619
Mailing Address - Country:US
Mailing Address - Phone:201-658-3404
Mailing Address - Fax:
Practice Address - Street 1:50 POLIFLY RD
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3287
Practice Address - Country:US
Practice Address - Phone:201-968-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13019800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse