MEDICARE: DR. ELLEN LOUISE CONNER 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	207VG0400X	Gynecology Physician	25MA07702900	NJ
2	207VX0201X	Gynecologic Oncology Physician	25MA07702900	NJ
3	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	25MA07702900	NJ

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	:	1609867100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN LOUISE CONNER MD

Provider Business Mailing Address
First Line	:	19 DAVIS AVE FL 7
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-4488
Country	:	US
Telephone Number	:	732-776-3797
Fax Number	:	732-776-3796

Provider Business Practice Location Address
First Line	:	19 DAVIS AVE FL 7
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-4488
Country	:	US
Telephone Number	:	732-776-3797
Fax Number	:	732-776-3796

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	11/30/2018

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