Active NPI
Gloria Laraine Ellis, R.N.
- Registered Nurse
- Brooklyn, NY
National Provider Identifier
1144507179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 313978-1
- Practice address
- 1663 E 17TH Street
Brooklyn, NY 11229 - Phone
- (718) 998-0200
- NPI assigned
- Nov 4, 2011
- Last updated
- Nov 4, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 313978-1 | NY | Primary |
Addresses
Primary practice location
1663 E 17TH Street
Brooklyn, NY 11229
Mailing address
109-43 126 Street
P.H.
South Ozone Park, NY 11420
Phone (347) 219-6824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 313978-1 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320364800000",
"number": "1144507179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109-43 126 STREET",
"address_2": "P.H.",
"city": "SOUTH OZONE PARK",
"state": "NY",
"postal_code": "11420",
"telephone_number": "347-219-6824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1663 E 17TH STREET",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11229",
"telephone_number": "718-998-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "GLORIA",
"middle_name": "LARAINE",
"name_prefix": "Ms.",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-04",
"last_updated": "2011-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "313978-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.