Healthcare Provider Details

I. General information

NPI: 1609867100
Provider Name (Legal Business Name): ELLEN LOUISE CONNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 7
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

19 DAVIS AVE FL 7
NEPTUNE NJ
07753-4488
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-3797
  • Fax: 732-776-3796
Mailing address:
  • Phone: 732-776-3797
  • Fax: 732-776-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA07702900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25MA07702900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA07702900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: