Provider Demographics
NPI:1952199028
Name:EBON IS LLC
Entity type:Organization
Organization Name:EBON IS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARICE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-749-3801
Mailing Address - Street 1:825 BOYNTON AVE APT 15L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4723
Mailing Address - Country:US
Mailing Address - Phone:347-749-3801
Mailing Address - Fax:
Practice Address - Street 1:825 BOYNTON AVE APT 15L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4723
Practice Address - Country:US
Practice Address - Phone:347-749-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty