Provider Demographics
NPI:1801831888
Name:ELLIS, CAROL O (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:O
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1250 ROUTE 28
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3389
Mailing Address - Country:US
Mailing Address - Phone:908-252-0242
Mailing Address - Fax:908-252-0243
Practice Address - Street 1:1250 ROUTE 28
Practice Address - Street 2:SUITE 203
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3389
Practice Address - Country:US
Practice Address - Phone:908-252-0242
Practice Address - Fax:908-252-0243
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06323000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation