Provider Demographics
NPI:1629244884
Name:ELLIS, JASON A (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:ELLIS
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 1:130 EAST 77TH STREET
Mailing Address - Street 2:DEPT. OF NEUROSURGERY, BLACK HALL, THIRD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-434-3900
Mailing Address - Fax:212-434-3899
Practice Address - Street 1:130 EAST 77TH STREET
Practice Address - Street 2:DEPT. OF NEUROSURGERY, BLACK HALL, THIRD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-434-3900
Practice Address - Fax:212-434-3899
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75452207T00000X
NY260313-1207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery