Provider Demographics
NPI:1982711313
Name:ETTINGER, ELLEN R (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:R
Last Name:ETTINGER
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 23RD ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5046
Mailing Address - Country:US
Mailing Address - Phone:917-583-1260
Mailing Address - Fax:
Practice Address - Street 1:530 E 23RD ST APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5046
Practice Address - Country:US
Practice Address - Phone:917-583-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV4454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist