Healthcare Provider Details

I. General information

NPI: 1902975717
Provider Name (Legal Business Name): ELLEN F CRAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S 1B-25 JACOBI MEDICAL CENTER
BRONX NY
10461-1138
US

IV. Provider business mailing address

801 W END AVE
NEW YORK NY
10025-5368
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5817
  • Fax: 718-918-7459
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number140614
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number140614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: