Provider Demographics
NPI:1457996811
Name:WHITTINGTON, EBONY M
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:M
Last Name:WHITTINGTON
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 1:1977 N OLDEN AVENUE EXT STE 232
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2113
Mailing Address - Country:US
Mailing Address - Phone:609-638-8703
Mailing Address - Fax:
Practice Address - Street 1:220 NEW HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3524
Practice Address - Country:US
Practice Address - Phone:609-638-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver