# SCOTT JACOB ELLIS MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104424621
- **Authorized official:** SCOTT JACOB ELLIS MD (PRESIDENT)
- **Authorized official phone:** (646) 797-8305

## Contact information

- **Practice address:** 523 E 72ND ST FL 5, NEW YORK, NY 10021-4099
- **Practice address phone:** (646) 797-8305
- **Practice address fax:** (646) 797-8515
- **Mailing address:** PO BOX 12184, HAUPPAUGE, NY 11788-0854

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | NULL | Yes |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/16/2020
- **Last updated:** 10/16/2020