Provider Demographics
NPI:1164016309
Name:ESTHER L ELLIS LLC
Entity Type:Organization
Organization Name:ESTHER L ELLIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:LIANA
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN
Authorized Official - Phone:225-803-3177
Mailing Address - Street 1:690 SAW MILL RIVER RD APT 3F
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1819
Mailing Address - Country:US
Mailing Address - Phone:872-256-6359
Mailing Address - Fax:
Practice Address - Street 1:1200 N ASHLAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8327
Practice Address - Country:US
Practice Address - Phone:872-256-6359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty