Individual
DR. ELLIS ENABOSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
455 JERSEY ST, STATEN ISLAND, NY 10301-2976
(187) 524-5611
Mailing address
1434 WILLIAMSBRIDGE RD FL 2, BRONX, NY 10461-2507
(718) 618-0401
(347) 479-1303
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
291470
NY
208D00000X
General Practice Physician
291470
NY
Other
Enumeration date
03/24/2015
Last updated
01/08/2021
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