Charles, Ellis B

Charles, Ellis B is an sole proprietor health care provider with primary practice located at 90 Washington St , East Orange NJ 07017-1050. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Charles, Ellis B can be contacted via phone (973) 672-2555.

Contact Information

Primary practice address
90 Washington St East Orange NJ 07017-1050
Phone: (973) 672-2555
Fax: (973) 672-2529
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 132910 New York
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 25MA05127300 New Jersey
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 18284 Georgia

Profile Details

NPI number 1013046341
LBN Legal business name Charles, Ellis B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 4th, 2007
Last updated Mar 5th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013046341 NPPES
New Jersey MEDICAID 0866300

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