Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 042362 | NY |
NPI | 1023230018 |
---|---|
Provider Name | Dr. Robin Samuel Ellis |
First Address | New York, NY 10023-4166 |
Second Address | New York, NY 10023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |