Provider Demographics
NPI:1669182580
Name:ANNA ELLERIN DDS PA
Entity type:Organization
Organization Name:ANNA ELLERIN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLERIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-743-8155
Mailing Address - Street 1:189 KINDERKAMACK RD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2289
Mailing Address - Country:US
Mailing Address - Phone:201-664-2419
Mailing Address - Fax:201-664-2906
Practice Address - Street 1:189 KINDERKAMACK RD STE A
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2289
Practice Address - Country:US
Practice Address - Phone:201-664-2419
Practice Address - Fax:201-664-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty