Healthcare Provider Details

I. General information

NPI: 1184951006
Provider Name (Legal Business Name): ELLEN KATHRYN SIDLES CM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 LINCOLN RD
BROOKLYN NY
11225-4358
US

IV. Provider business mailing address

399 LINCOLN RD
BROOKLYN NY
11225-4358
US

V. Phone/Fax

Practice location:
  • Phone: 347-628-2108
  • Fax: 929-273-2482
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: