Provider Demographics
NPI:1285947119
Name:SINGHA, EBENEZER M (MS)
Entity type:Individual
Prefix:MR
First Name:EBENEZER
Middle Name:M
Last Name:SINGHA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HURON ST
Mailing Address - Street 2:
Mailing Address - City:INDUSTRY
Mailing Address - State:PA
Mailing Address - Zip Code:15052-1725
Mailing Address - Country:US
Mailing Address - Phone:724-643-1000
Mailing Address - Fax:
Practice Address - Street 1:387 STATE AVE
Practice Address - Street 2:
Practice Address - City:VANPORT
Practice Address - State:PA
Practice Address - Zip Code:15009-1632
Practice Address - Country:US
Practice Address - Phone:724-643-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04130501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10095567001Medicaid
PA10095567001Medicaid