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General NPI Number Information
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NPI Number | 1477768372
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Entity Type | Individual
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Provider Name | JOHN ELLA PA
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 420 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10170-0002
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Country | US
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Telephone | 212-499-4720
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Fax |
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Provider Business Mailing Address
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Address Line | 38 JUNIPER ST
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City | JERSEY CITY
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State | NJ
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Zip | 07305-4827
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Country | US
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Telephone | 201-536-1979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 007569
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License Number State | NY
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