Individual
JOHN M ELLIS
Active
Individual
JOHN M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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