Provider Demographics
NPI:1891051306
Name:DABELA, ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:DABELA
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 588
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08528-0588
Mailing Address - Country:US
Mailing Address - Phone:609-222-4702
Mailing Address - Fax:609-297-3760
Practice Address - Street 1:601 EWING ST STE C3
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2756
Practice Address - Country:US
Practice Address - Phone:609-222-4702
Practice Address - Fax:609-297-3760
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283165207N00000X
CAA142720207N00000X
NJ25MA10116400207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology