MEDICARE: MR. EDWARD JACOB ELLES II LCSW

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	1041C0700X	Clinical Social Worker	082680	NY

General Provider Information

NPI Number	:	1265696025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD JACOB ELLES II LCSW

Provider Business Mailing Address
First Line	:	424 W 49TH ST APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-7213
Country	:	US
Telephone Number	:	808-854-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 W 49TH ST APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-7213
Country	:	US
Telephone Number	:	808-854-5711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/15/2025

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