Active NPI
David Welford Ellis, PH.D.
- School Psychologist
- Salem, NJ
National Provider Identifier
1053451476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- SI01417
- Practice address
- 325 Route 45
Salem, NJ 08079-2045 - Phone
- (856) 878-0800
- Fax
- (856) 878-0800
- NPI assigned
- Feb 7, 2007
- Last updated
- Sep 11, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | SI01417 | NJ | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | SI01417 | NJ | |
| Rehabilitation Psychologist | 103TR0400X | SI01417 | NJ | |
| School Psychologist | 103TS0200X | SI01417 | NJ | Primary |
Addresses
Primary practice location
325 Route 45
Salem, NJ 08079-2045
Mailing address
325 Route 45
Salem, NJ 08079-2045
Phone (856) 878-0800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040422001535 | NJ | Practitioner - Clinical Psychologist | 7517953748 | Practice locations: Pennsville, NJ |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Duke University School of Medicine, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3 Carroll Ave
Pennsville, NJ 08070-2129
Phone (856) 878-0500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SI01417 | NJ | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1053451476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 ROUTE 45",
"city": "SALEM",
"state": "NJ",
"postal_code": "080792045",
"telephone_number": "856-878-0800",
"fax_number": "856-878-0800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 ROUTE 45",
"city": "SALEM",
"state": "NJ",
"postal_code": "080792045",
"telephone_number": "856-878-0800",
"fax_number": "856-878-0800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DAVID",
"middle_name": "WELFORD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NJ",
"license": "SI01417",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NJ",
"license": "SI01417",
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "NJ",
"license": "SI01417",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NJ",
"license": "SI01417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.