Individual
KELSEY ENSOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
451 CLARKSON AVE, BROOKLYN, NY 11203-2097
(718) 245-4686
Mailing address
150 55TH ST, BROOKLYN, NY 11220-2508
(718) 630-7000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
125064451
IL
2086S0102X
Surgical Critical Care Physician
Primary
311934
NY
390200000X
Student in an Organized Health Care Education/Training Program
125064451
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E523651284720
DRIVERS LICENSE
IL
Enumeration date
08/06/2014
Last updated
11/05/2023
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