Individual
DR. JEFFREY IRA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
358 S OYSTER BAY RD, HICKSVILLE, NY 11801-3508
(516) 822-7546
(516) 937-7546
Mailing address
358 S OYSTER BAY RD, HICKSVILLE, NY 11801-3508
(516) 822-7546
(516) 937-7546
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
234545
NY
207ND0101X
MOHS-Micrographic Surgery Physician
234545
NY
207NP0225X
Pediatric Dermatology Physician
234545
NY
207NS0135X
Procedural Dermatology Physician
Primary
234545-01
NY
Other
Enumeration date
08/18/2006
Last updated
11/02/2021
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