Physician Compare National (NPI:1669866158)

HEALTHCARE PROVIDER: ELLIS ENABOSI M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1669866158
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274890272
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171129002536
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ENABOSI
	Individual professional last name
Provider First Name	ELLIS
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	455 JERSEY ST
	Group Practice or individual's line 1 address
City	STATEN ISLAND
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	103012976
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y