Provider Demographics
NPI:1083726798
Name:ELLER, JORGE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:ELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 W FAYETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2866
Mailing Address - Country:US
Mailing Address - Phone:315-937-3433
Mailing Address - Fax:315-937-3957
Practice Address - Street 1:739 IRVING AVE STE 600
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1663
Practice Address - Country:US
Practice Address - Phone:315-701-2550
Practice Address - Fax:315-701-2551
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD453180207T00000X
ORMD24962207T00000X
CAC178389207T00000X
NY258352207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery