Individual
MR. EBENEZER PREMKUMAR THANGAVELU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
143 S 9TH ST, LINDENHURST, NY 11757-4523
(516) 983-5754
Mailing address
143 SOUTH 9TH STREET, LINDENHURST, NY 11757
(631) 957-1859
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F 302708-1
NY
Other
Enumeration date
10/18/2005
Last updated
05/18/2016
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