Individual
CARL ELLISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DABR
Contact information
Practice address
622 W 168TH ST, DEPARTMENT OF RADIATION ONCOLOGY, NEW YORK, NY 10032
(212) 305-4295
Mailing address
153 MANHASSET AVE, MANHASSET, NY 11030-2219
(917) 501-2367
Taxonomy
Speciality
Code
Description
License number
State
2085R0205X
Radiological Physics Physician
Primary
000507
NY
Other
Enumeration date
11/02/2020
Last updated
11/02/2020
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