Stephen J. Ellis, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA03904800 Issued in NJ

Practice address

210 Jack Martin Blvd
Suite D-1
Brick, NJ 08724-7771

Phone

(732) 458-5067

Fax

(732) 458-4962

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1801831854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 JACK MARTIN BLVD",
            "address_2": "SUITE D-1",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087247771",
            "telephone_number": "732-458-5067",
            "fax_number": "732-458-4962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 JACK MARTIN BLVD",
            "address_2": "SUITE D-1",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087247771",
            "telephone_number": "732-458-5067",
            "fax_number": "732-458-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "STEPHEN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA03904800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4871405",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "390003718",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Eliachevsky, MD
• Lauren Eliasen, M.S., CCC-SLP
• Elite Chiropractic and Recovery
• Elizabeth L Barton, MSW, LCSW, LLC
• Megen Melissa Elliott, LPC
• Elmhurst Operator LLC
• Nashwa Emara
• Emdazz Health Services
• Emdazz Health Services
• Emdazz Health Services

• Specialist in Brick, NJ
• Providers in Brick, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; 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.