Provider Demographics
NPI:1326048265
Name:ROONEY, ELLEN MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:ROONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0334
Mailing Address - Country:US
Mailing Address - Phone:212-734-5533
Mailing Address - Fax:212-717-1688
Practice Address - Street 1:111 E 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0334
Practice Address - Country:US
Practice Address - Phone:212-734-5533
Practice Address - Fax:212-717-1688
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY63F891OtherEMPIRE BC/BS
NYNP997OtherOXFORD
NYE62455Medicare UPIN
NY63F891Medicare ID - Type Unspecified