MEDICARE: ELLEN MELLOW 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	146454	NY
2	207RC0000X	Cardiovascular Disease Physician	146454	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366444259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN MELLOW MD

Provider Business Mailing Address
First Line	:	121 E 60TH ST
Second Line	:	#2C
City	:	NEW YORK
State	:	NY
Zip	:	10022-1117
Country	:	US
Telephone Number	:	212-838-4114
Fax Number	:	212-838-4145

Provider Business Practice Location Address
First Line	:	115 E 57TH ST
Second Line	:	STE 510
City	:	NEW YORK
State	:	NY
Zip	:	10022-2221
Country	:	US
Telephone Number	:	212-838-4114
Fax Number	:	212-838-4145

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/10/2017

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Directions to “ ELLEN MELLOW MD” Practice Location

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