Provider Demographics
NPI:1255731634
Name:EBITZ, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:EBITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E BROADWAY
Mailing Address - Street 2:APT #5H1
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:855 E BROADWAY
Practice Address - Street 2:APT #5H1
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4757
Practice Address - Country:US
Practice Address - Phone:516-987-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse