Healthcare Provider Details

I. General information

NPI: 1730126772
Provider Name (Legal Business Name): ELLEN KAPLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5207
  • Fax: 551-996-4969
Mailing address:
  • Phone: 551-996-5207
  • Fax: 551-996-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number61756
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: