Individual
ELLEN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
67 PARK AVE, #12B, NEW YORK, NY 10016-2557
(516) 650-8444
Mailing address
67 PARK AVE, #12B, NEW YORK, NY 10016-2557
(516) 650-8444
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
154539
NY
Other
Enumeration date
12/01/2014
Last updated
01/19/2017
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