Provider Demographics
NPI:1821833765
Name:ETERNITY HEALTH LLC
Entity type:Organization
Organization Name:ETERNITY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-238-9856
Mailing Address - Street 1:ROVIRA OFFICE PARK 623 AVE. LA CEIBA
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROVIRA OFFICE PARK 623 AVE. LA CEIBA
Practice Address - Street 2:SUITE 201
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1901
Practice Address - Country:US
Practice Address - Phone:939-238-9856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty