Individual
DR. STEPHEN J. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 JACK MARTIN BLVD, SUITE D-1, BRICK, NJ 08724-7771
(732) 458-5067
(732) 458-4962
Mailing address
210 JACK MARTIN BLVD, SUITE D-1, BRICK, NJ 08724-7771
(732) 458-5067
(732) 458-4962
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA03904800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390003718
RAILROAD MEDICARE NUMBER
—
05
—
4871405
—
NJ
Enumeration date
06/16/2006
Last updated
10/17/2014
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