Provider Demographics
NPI:1306839592
Name:ENNIS, DAVID TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TODD
Last Name:ENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4400
Mailing Address - Country:US
Mailing Address - Phone:914-962-3500
Mailing Address - Fax:
Practice Address - Street 1:1838 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4400
Practice Address - Country:US
Practice Address - Phone:914-962-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2C5048OtherHEALTHET
4245064OtherAETNA - PPO
CK0751OtherRR MEDICARE
120894OtherCIGNA
961517OtherAETNA - HMO
148653OtherUNITED
WP483OtherOXFORD
NY00970489Medicaid
WS0001194OtherSELECT PRO
A64202Medicare UPIN
WS0001194OtherSELECT PRO