Individual
JONATHAN PHILLIP ELLANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 KENNEDY DR STE 400, HAUPPAUGE, NY 11788-4017
(631) 265-8780
Mailing address
114 E 27TH ST, NEW YORK, NY 10016-8969
(631) 265-8780
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
195706
NY
207W00000X
Ophthalmology Physician
Primary
195706
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01667945
—
NY
Enumeration date
11/14/2006
Last updated
01/29/2021
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