Organization
EBC HEALTH
Active
Organization
EBC HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENDAN J KEYS SR. NP (OWNER)
(516) 524-0665
Entity
Organization
Contact information
Practice address
135 PARK BLVD, MASSAPEQUA PARK, NY 11762-3643
(516) 524-0665
Mailing address
209 FILLMORE ST, MASSAPEQUA PARK, NY 11762-1513
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F334247
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02523857
—
NY
01
—
0472G1
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/19/2008
Last updated
06/13/2008
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