Provider Demographics
NPI:1609867100
Name:CONNER, ELLEN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:LOUISE
Last Name:CONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DAVIS AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4488
Mailing Address - Country:US
Mailing Address - Phone:732-776-3797
Mailing Address - Fax:732-776-3796
Practice Address - Street 1:19 DAVIS AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-776-3797
Practice Address - Fax:732-776-3796
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07702900207VG0400X, 207VX0201X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043214Medicaid
NJ084744UUGMedicare PIN
NJH73278Medicare UPIN
NJ08474NSVMedicare ID - Type Unspecified