Earl Anthony Ellis, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

149280 Issued in NY

Practice address

66 Rutland Rd
Brooklyn, NY 11225-5313

Phone

(718) 282-4412

Fax

(718) 856-8055

NPI assigned

Feb 10, 2006

Last updated

Jun 4, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338768000000",
    "number": "1205809050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 RUTLAND RD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112255313",
            "telephone_number": "718-282-4412",
            "fax_number": "718-856-8055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 RUTLAND RD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112255313",
            "telephone_number": "718-282-4412",
            "fax_number": "718-856-8055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "EARL",
        "middle_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2012-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "149280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "149280",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Ellis
• Catherine Ellis
• Catherine Elizabeth Ellis, DO
• Cynthia Marie Ellis, LCSW,CASAC
• Darnette Ann-Marie Ellis, LMSW
• Eugene Ellis, MD
• Gavin N Ellis
• Gloria Laraine Ellis, R.N.
• Jasmine Ellis
• Judith M Ellis, NP

• Internal Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.