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General NPI Number Information
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NPI Number | 1639664154
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Entity Type | Individual
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Provider Name | ELAINA NELLIS OD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 12 NEW PALTZ PLZ
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City | NEW PALTZ
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State | NY
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Zip | 12561-1616
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Country | US
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Telephone | 845-255-6780
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Fax |
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Provider Business Mailing Address
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Address Line | 1582 HAINESPORT MOUNT LAUREL RD
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-9552
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Country | US
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Telephone |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 008810
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00708100
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License Number State | NJ
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