| Doctor Name: | MAE LUCILLE EBARDO |
| NPI Number: | 1699842153 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 225100000X |
| Business Practice Address: | 2854 Kennedy Blvd Jersey City, NJ - 073064014 |
| Business Phone Number: | 2017922582 |
| Business Fax Number: | 2016565925 |
| Mailing Address: | 252 Clendenny Ave, Apt 2 JERSEY CITY |
| State: | NJ |
| Postal Code: | 073041182 |
| Phone Number: | 5519986651 |
| Fax Number: | 2017637931 |
| NPI Enumeration Date: | 11/29/2006 |
| NPI Last Update Date: | 10/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 225100000X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |