Individual
EARL ANTHONY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
66 RUTLAND RD, BROOKLYN, NY 11225-5313
(718) 282-4412
(718) 856-8055
Mailing address
66 RUTLAND RD, BROOKLYN, NY 11225-5313
(718) 282-4412
(718) 856-8055
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
149280
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149280
STATE LICENSE NUMBER
NY
Enumeration date
02/10/2006
Last updated
06/04/2012
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