Healthcare Provider Details

I. General information

NPI: 1831681501
Provider Name (Legal Business Name): CAITLIN ASHLEIGH ENSOR MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

535 E 70TH ST
NEW YORK NY
10021-4823
US

V. Phone/Fax

Practice location:
  • Phone: 917-260-3909
  • Fax: 917-260-4522
Mailing address:
  • Phone: 917-260-3909
  • Fax: 917-260-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number318361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: