Provider Demographics
NPI:1982760385
Name:GERRY, ELLYN (NP)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:
Last Name:GERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E 86TH ST
Mailing Address - Street 2:APT. 10B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6433
Mailing Address - Country:US
Mailing Address - Phone:917-763-9633
Mailing Address - Fax:212-423-8121
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:ROOM 4B5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:212-423-6796
Practice Address - Fax:212-423-8121
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420343363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health