Provider Demographics
NPI:1447079579
Name:BRANCH, EBONI (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:BRANCH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 OGDEN AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2301
Mailing Address - Country:US
Mailing Address - Phone:646-745-4974
Mailing Address - Fax:
Practice Address - Street 1:TANDYM GROUP
Practice Address - Street 2:675 3RD AVE 5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-922-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY935675-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse