Individual
DR. JERROLD J ELLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
140 BERGEN ST # D, NEWARK, NJ 07103
(973) 972-4071
(973) 972-3102
Mailing address
30 BERGEN ST RM 1205, NEWARK, NJ 07107-3000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
242471
MA
207RI0200X
Infectious Disease Physician
Primary
242471
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110086419A
—
MA
05
—
8201200
—
NJ
Enumeration date
05/08/2007
Last updated
02/03/2022
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