Individual
DR. JEFFREY MARK ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.,C.N.S
Contact information
Practice address
3237 ROUTE 112, BLDG 6, MEDFORD, NY 11763-1424
(631) 698-6934
(631) 698-5361
Mailing address
3237 ROUTE 112, BLDG 6, MEDFORD, NY 11763-1424
(631) 698-6934
(631) 698-5361
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
039551
NY
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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