Provider Demographics
NPI:1417398397
Name:ELLIN, CATHERINE (MS)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:ELLIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NETHERLAND AVE
Mailing Address - Street 2:APT 6E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3438
Mailing Address - Country:US
Mailing Address - Phone:646-260-3845
Mailing Address - Fax:
Practice Address - Street 1:3300 NETHERLAND AVE
Practice Address - Street 2:APT 6E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3438
Practice Address - Country:US
Practice Address - Phone:646-260-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist