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General NPI Number Information
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NPI Number | 1922042225
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Entity Type | Individual
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Provider Name | CARMEN JAY ELLIE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 191 N MAIN ST
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City | WELLSVILLE
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State | NY
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Zip | 14895-1150
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Country | US
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Telephone | 585-235-1514
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Fax | 585-426-4997
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Provider Business Mailing Address
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Address Line | 345 COUNTRY WOODS LN
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City | ROCHESTER
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State | NY
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Zip | 14626-4701
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Country | US
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Telephone | 585-225-9230
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Fax | 585-225-9739
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 191341-1
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License Number State | NY
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