Provider Demographics
NPI:1578661351
Name:ELLMAN, BARRY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:RICHARD
Last Name:ELLMAN
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 1:98 JAMES ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-906-8501
Mailing Address - Fax:732-906-8502
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-906-8501
Practice Address - Fax:732-906-8502
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051969000OtherAMERIHEALTH
NJ0288705Medicaid
NJ1K4367OtherHEALTHNET
NJP882390OtherOXFORD INSURANCE
NJ1K4367OtherHEALTHNET
NJEL046256Medicare ID - Type UnspecifiedFEDERAL MEDICARE