MEDICARE: ESTHER L ELLIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1164016309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTHER L ELLIS LLC

Provider Business Mailing Address
First Line	:	690 SAW MILL RIVER RD APT 3F
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-1819
Country	:	US
Telephone Number	:	872-256-6359
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N ASHLAND AVE STE 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8327
Country	:	US
Telephone Number	:	872-256-6359
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN NUTRITIONIST
Name	:	ESTHER LIANA ELLIS
Credential	:	MS, RDN, LDN
Telephone Number	:	225-803-3177

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/14/2023

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