Individual provider Active NPI

Debra Ellis

  • Registered Nurse
  • Kew Gardens Hills, NY
National Provider Identifier
1336074665
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
953349 Issued in NY
Practice address
7525 153Rd St Apt 202
Kew Gardens Hills, NY 11367-3091
Phone
(347) 942-7043
NPI assigned
Jun 17, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 953349 NY Primary

Addresses

Primary practice location

7525 153Rd St Apt 202
Kew Gardens Hills, NY 11367-3091

Mailing address

265 Broadhollow Rd Ste 200
Melville, NY 11747-4833

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

NPI Registry JSON

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

{
    "created_epoch": "1781654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1336074665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 BROADHOLLOW RD STE 200",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7525 153RD ST APT 202",
            "city": "KEW GARDENS HILLS",
            "state": "NY",
            "postal_code": "113673091",
            "telephone_number": "347-942-7043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DEBRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-06-17",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "953349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kew Gardens Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; 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.