Provider Demographics
NPI:1609810233
Name:LAND, ELLEN (APN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FARM RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-1427
Mailing Address - Country:US
Mailing Address - Phone:609-538-1797
Mailing Address - Fax:
Practice Address - Street 1:5 PLAINSBORO ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:609-853-7272
Practice Address - Fax:609-853-7271
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC06275000364SG0600X
NJ26NN06275000363LF0000X
NY26NNO6275000364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS73307Medicare UPIN
004202A75Medicare ID - Type Unspecified