DR. EUGENE ELLIS MD NPI 1194721142

NPI Information

NPI: 1194721142
Provider Name: DR. EUGENE ELLIS, MD
Classification: Specialist - 174400000X
Entity Type: Individual

PECOS Registration: Yes

Address:
967 48TH ST
BROOKLYN, NY
ZIP 11219
Phone: (718) 283-3000
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DR. Eugene Ellis, MD is a specialist in Brooklyn, NY with 43 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DR. Eugene Ellis, MD NPI is 1194721142. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: NEW YORK UNIVERSITY MEDICAL COLLEGE - NLG
Graduation Year:1981

The provider's business location address is:

967 48TH ST
BROOKLYN, NY
ZIP 11219-919
Phone: (718) 283-3000
Fax: (718) 238-6818

The NPI 1194721142 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/23/2005 and was last updated on 12/8/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		136939-1	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	62A621	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK
2	B78347	MEDICARE UPIN	NEW YORK
3	01862853	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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