Individual
JOHN M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1656 CHAMPLIN AVE, UTICA, NY 13502-4830
(315) 624-6116
Mailing address
185 GENESEE ST STE 600, UTICA, NY 13501-2110
(315) 793-8806
(315) 793-8046
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
209356
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01874611
—
NY
01
—
040426013962
FIDELIS
NY
01
—
10037625
CDPHP
NY
01
—
209356-1
WC
NY
01
—
300099765
RAIL ROAD MEDICARE
NY
01
—
4199650
GHI
NY
01
—
960976
MVP
NY
01
—
P010209356
BCBS
NY
Enumeration date
04/05/2006
Last updated
10/15/2025
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