Ellant, Jonathan Phillip

Ellant, Jonathan Phillip is an sole proprietor health care provider with primary practice located at 125 Kennedy Dr Ste 400 , Hauppauge NY 11788-4017. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Ophthalmology. Allopathic & Osteopathic Physicians / Ophthalmology is his primary health care specialty. Ellant, Jonathan Phillip can be contacted via phone (631) 265-8780.

Contact Information

Primary practice address
125 Kennedy Dr Ste 400 Hauppauge NY 11788-4017
Phone: (631) 265-8780
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 195706 New York
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 195706 New York

Profile Details

NPI number 1306918669
LBN Legal business name Ellant, Jonathan Phillip
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 14th, 2006
Last updated Jan 29th, 2021 - about 4 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 1306918669 NPPES
New York MEDICAID 01667945

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