MEDICARE: YASMINA OSIRIS ELLIS

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1700227899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASMINA OSIRIS ELLIS

Provider Business Mailing Address
First Line	:	3358 HULL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-3306
Country	:	US
Telephone Number	:	646-548-5304
Fax Number	:

Provider Business Practice Location Address
First Line	:	3358 HULL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-3306
Country	:	US
Telephone Number	:	646-548-5304
Fax Number	:

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	04/29/2016

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Directions to “ YASMINA OSIRIS ELLIS ” Practice Location

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