Provider Demographics
NPI:1780722751
Name:ELLEN SUE GINSBERG DO PC
Entity type:Organization
Organization Name:ELLEN SUE GINSBERG DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-320-9000
Mailing Address - Street 1:1981 MARCUS AVE STE C114
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1032
Mailing Address - Country:US
Mailing Address - Phone:516-987-4200
Mailing Address - Fax:800-297-0976
Practice Address - Street 1:2100 BARTOW AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4614
Practice Address - Country:US
Practice Address - Phone:718-320-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172644-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE71224Medicare UPIN
NY11A121Medicare ID - Type Unspecified