MEDICARE: THOMASENA L ELLISON MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	1802491	NY

General Provider Information

NPI Number	:	1083859425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMASENA L ELLISON MD PC

Provider Business Mailing Address
First Line	:	100 LIVINGSTON ST
Second Line	:	SUITE 3
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5023
Country	:	US
Telephone Number	:	718-222-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 LIVINGSTON ST
Second Line	:	SUITE 3
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5023
Country	:	US
Telephone Number	:	718-222-0393
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	THOMASENA L ELLISON
Credential	:	MD
Telephone Number	:	718-222-0393

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	07/02/2014

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