Individual
THOMASENA L ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD FACOG
Contact information
Practice address
100 LIVINGSTON STREET, 3RD FLOOR, BROOKLYN, NY 11201
(718) 222-0393
(718) 222-3653
Mailing address
100 LIVINGSTON STREET, 3RD FLOOR, BROOKLYN, NY 11201
(718) 222-0393
(718) 222-3653
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
1802491
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202017
GHI
—
01
—
112619613EL02
CARE PLUS
—
01
—
255780401
HEALTH PLUS
—
01
—
30310P
HIP
—
01
—
3C1694
HEALTHNET
—
01
—
ET0249
ATLANTIS
—
01
—
N323923
WELL CARE
—
01
—
P406658
OXFORD
—
01
—
T4X
ETIN
—
Enumeration date
10/23/2006
Last updated
07/02/2014
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