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NPI Code Detail

MEDICARE: MS. JUDITH M ELLIS NP

MEDICARE: MS. JUDITH M ELLIS NP
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
1363L00000XNurse PractitionerF381716-1NY

General Provider Information

NPI Number : 1851383939
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUDITH M ELLIS NP
Provider Business Mailing Address
First Line : 296 ROCKAWAY PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-3352
Country : US
Telephone Number : 718-485-2383
Fax Number : 718-485-2383
Provider Business Practice Location Address
First Line : 1 BROOKDALE PLZ
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-3139
Country : US
Telephone Number : 718-240-6225
Fax Number : 718-240-8063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 07/08/2007

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