Provider Demographics
NPI:1649064759
Name:EZEORAH, FRANKLIN
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:
Last Name:EZEORAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 THROOP AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2433
Mailing Address - Country:US
Mailing Address - Phone:940-268-9424
Mailing Address - Fax:
Practice Address - Street 1:234 AIRPORT PLAZA BLVD STE 11B
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3917
Practice Address - Country:US
Practice Address - Phone:631-767-1589
Practice Address - Fax:631-504-0326
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39752101YA0400X
NY18-P133566-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)