Provider Demographics
NPI:1467672097
Name:CARROLL, ELLEN M (PNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GLEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-3657
Mailing Address - Country:US
Mailing Address - Phone:203-531-1646
Mailing Address - Fax:
Practice Address - Street 1:246 GREENE ST
Practice Address - Street 2:NYUCN MOBILE HEALTH SERVICES, ROOM 713 W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6677
Practice Address - Country:US
Practice Address - Phone:212-998-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF 380919363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics