Provider Demographics
NPI:1376716035
Name:ELLIS, WILLIAM (AUD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:ELLIS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MARGARET RD
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1903
Mailing Address - Country:US
Mailing Address - Phone:516-579-6248
Mailing Address - Fax:516-579-6248
Practice Address - Street 1:430 LAKEVILLE RD
Practice Address - Street 2:HEARING AND SPEECH
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:718-470-8910
Practice Address - Fax:718-347-8241
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000993-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist