Individual
DANIEL THOMAS ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18 LAUREL RD E, STRATFORD, NJ 08084-1327
(856) 346-7816
(856) 346-6385
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
(856) 686-4300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MA78633
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0068489
—
NJ
Enumeration date
06/14/2006
Last updated
12/14/2009
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