Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 230125 | NY |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 230125 | NY |
NPI | 1336359587 |
---|---|
Provider Name | Dr. Scott J. Ellis |
First Address | New York, NY 10087-9234 |
Second Address | New York, NY 10021-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02859992 | (05) | NY |