Individual
MARK KENNETH ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 5TH AVE APT 2D, NEW YORK, NY 10011-8832
(914) 393-2368
Mailing address
2 5TH AVE APT 2D, NEW YORK, NY 10011-8832
(914) 393-2368
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
R72186
AZ
Other
Enumeration date
06/29/2010
Last updated
06/02/2014
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