Individual
STEPHANIE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
135 W 50TH ST FL 6, NEW YORK, NY 10020-1201
(212) 582-9100
Mailing address
3004 HEATH AVE APT 33, BRONX, NY 10463-5962
(347) 786-4058
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
330768990
NY
Other
Enumeration date
03/21/2022
Last updated
03/21/2022
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