Provider Demographics
NPI:1174286744
Name:GINA M. ELLERY, LLC
Entity Type:Organization
Organization Name:GINA M. ELLERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:ELLERY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:215-859-7238
Mailing Address - Street 1:604 HARLEYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2824
Mailing Address - Country:US
Mailing Address - Phone:215-859-7238
Mailing Address - Fax:
Practice Address - Street 1:671 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1772
Practice Address - Country:US
Practice Address - Phone:215-859-3858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty