Individual
RAYMOND S ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
74 COMMERCE DR. #3, RIVERHEAD, NY 11947
(631) 369-9110
Mailing address
PO BOX 336, JAMESPORT, NY 11947-0336
(631) 830-1460
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
NY
Other
Enumeration date
07/19/2017
Last updated
07/19/2017
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