Provider Demographics
NPI:1215774518
Name:EBRON, JASMINE MARIE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIE
Last Name:EBRON
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 1:8426 90TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1328
Mailing Address - Country:US
Mailing Address - Phone:678-232-6913
Mailing Address - Fax:
Practice Address - Street 1:10814 72ND AVE STE 2
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5301
Practice Address - Country:US
Practice Address - Phone:347-392-4482
Practice Address - Fax:347-392-4492
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist