Individual
DR. CARMEN JAY ELLIE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
191 N MAIN ST, WELLSVILLE, NY 14895-1150
(585) 235-1514
(585) 426-4997
Mailing address
345 COUNTRY WOODS LN, ROCHESTER, NY 14626-4701
(585) 225-9230
(585) 225-9739
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
191341-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000523980003
BCBS
NY
05
—
01487365
—
NY
01
—
110179566
RRM LEGACY#
NY
01
—
P00392597
RAILROAD
NY
Enumeration date
06/16/2006
Last updated
01/11/2011
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