Active NPI
Carissa Ellis, R.N.
- Registered Nurse
- Mastic Beach, NY
National Provider Identifier
1740632496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 22 717140
- Practice address
- 74 Mill Dr
Mastic Beach, NY 11951-1403 - Phone
- (631) 578-5758
- NPI assigned
- Jul 6, 2016
- 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 | 22 717140 | NY | Primary |
Addresses
Primary practice location
74 Mill Dr
Mastic Beach, NY 11951-1403
Mailing address
PO Box 5582
Bay Shore, NY 11706-0411
Phone (631) 578-5758
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 |
|---|---|---|---|
| 22 717140 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467763200000",
"number": "1740632496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5582",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117060411",
"telephone_number": "631-578-5758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74 MILL DR",
"city": "MASTIC BEACH",
"state": "NY",
"postal_code": "119511403",
"telephone_number": "631-578-5758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CARISSA",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-06",
"last_updated": "2016-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "22 717140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mastic Beach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.