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General NPI Number Information
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NPI Number | 1497369615
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Entity Type | Organization
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Legal Business Name | ELLISTON PEDIATRICS, PLLC
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 82 NASSAU ST # 60518
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City | NEW YORK
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State | NY
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Zip | 10038-3703
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Country | US
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Telephone | 917-746-2455
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Fax | 917-746-9649
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Provider Business Mailing Address
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Address Line | 82 NASSAU ST # 60518
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City | NEW YORK
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State | NY
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Zip | 10038-3703
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Country | US
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Telephone | 917-746-2455
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JAIME HILLIARD
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Credential |
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Telephone | 443-286-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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