Provider Demographics
NPI:1710961602
Name:SHER, ELLEN RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:RUTH
Last Name:SHER
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:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:802 W PARK AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-8527
Practice Address - Country:US
Practice Address - Phone:732-695-2555
Practice Address - Fax:732-695-2552
Is Sole Proprietor?:No
Enumeration Date:2005-12-04
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD59455207K00000X
NJ25MA05945500207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6088902Medicaid
NJ036075ZKRPOtherMEDICARE PTAN
NJ036075ZVF5OtherMEDICARE PTAN