MEDICARE: DR. DAVID TODD ENNIS MD

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	207R00000X	Internal Medicine Physician	160802	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CK0751	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2C5048	OTHER	HEALTHET
2	4245064	OTHER	AETNA - PPO
4	120894	OTHER	CIGNA
5	961517	OTHER	AETNA - HMO
6	148653	OTHER	UNITED
7	WP483	OTHER	OXFORD
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	WS0001194	OTHER	SELECT PRO

General Provider Information

NPI Number	:	1306839592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID TODD ENNIS MD

Provider Business Mailing Address
First Line	:	1838 COMMERCE ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4400
Country	:	US
Telephone Number	:	914-962-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1838 COMMERCE ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4400
Country	:	US
Telephone Number	:	914-962-3500
Fax Number	:

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/29/2011

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