Ellison, Irene
Ellison, Irene is an individual health care provider with primary practice located at 471 Barnum Ave , Bridgeport CT 06608-2409. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Ellison, Irene can be contacted via phone (203) 333-6864.Contact Information
Primary practice address
471 Barnum Ave
Bridgeport CT 06608-2409
Phone: (203) 333-6864
Fax: (203) 333-6864
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Hygienist | 124Q00000X |
Profile Details
| NPI number | 1083697916 |
|---|---|
| LBN Legal business name | Ellison, Irene |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 23rd, 2005 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083697916 | NPPES |
| Connecticut | Other | 001954 | STATE LICENSE |
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