Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | XXX | NJ |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25MA09460000 | NJ |
NPI | 1679887103 |
---|---|
Provider Name | Dr. Ellen Dean-Davis |
First Address | Boston, MA 02241-6457 |
Second Address | Morristown, NJ 07960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 12/06/2018 |