Active NPI
Nicholas Robert Ellis
- Occupational Therapist
- Philadelphia, PA
National Provider Identifier
1639501356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 2509 S 4TH St
Philadelphia, PA 19148-4712 - Phone
- (215) 271-1080
- NPI assigned
- Aug 5, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
2509 S 4TH St
Philadelphia, PA 19148-4712
Mailing address
2509 S 4TH St
Philadelphia, PA 19148-4712
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": "1375660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1639501356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2509 S 4TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191484712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2509 S 4TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191484712",
"telephone_number": "215-271-1080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "NICHOLAS",
"middle_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-05",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.