Healthcare Provider Details

I. General information

NPI: 1568301307
Provider Name (Legal Business Name): MARVALYN ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROUTE 22 STE 2000
BRIDGEWATER NJ
08807-2943
US

IV. Provider business mailing address

1200 ROUTE 22 STE 2000
BRIDGEWATER NJ
08807-2943
US

V. Phone/Fax

Practice location:
  • Phone: 732-498-2960
  • Fax:
Mailing address:
  • Phone: 732-498-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberHP0426700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: