Individual
MARY KRISTINE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
196 MERRICK RD, OCEANSIDE, NY 11572-1420
(516) 255-8400
Mailing address
1 HEALTHY WAY, OCEANSIDE, NY 11572-1551
(516) 255-8400
(516) 255-8453
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
277569
NY
207Q00000X
Family Medicine Physician
ME116438
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2010
Last updated
12/06/2022
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