Individual
MR. BENJAMIN MARK EBERLEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.N.A
Contact information
Practice address
8712 CLIO ST, HOLLIS, NY 11423-1200
(703) 863-5325
Mailing address
8712 CLIO ST, HOLLIS, NY 11423-1200
(703) 863-5325
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
342912450110E
NY
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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