Provider Demographics
NPI:1922692052
Name:ELLEN MELLOW MD, PLLC
Entity Type:Organization
Organization Name:ELLEN MELLOW MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-287-7342
Mailing Address - Street 1:184 E 70TH ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5154
Mailing Address - Country:US
Mailing Address - Phone:212-287-7342
Mailing Address - Fax:
Practice Address - Street 1:184 E 70TH ST UNIT 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5154
Practice Address - Country:US
Practice Address - Phone:212-287-7342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty