Ellner, Jerrold J
Ellner, Jerrold J is an individual health care provider with primary practice located at 140 Bergen St # D , Newark NJ 07103. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Infectious Disease. Allopathic & Osteopathic Physicians / Infectious Disease is his primary health care specialty. Ellner, Jerrold J can be contacted via phone (973) 972-4071.Contact Information
Primary practice address
140 Bergen St # D
Newark NJ 07103
Phone: (973) 972-4071
Fax: (973) 972-3102
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 242471 | Massachusetts |
| Allopathic & Osteopathic Physicians / Infectious Disease | 207RI0200X | 242471 | Massachusetts |
Profile Details
| NPI number | 1174736797 |
|---|---|
| LBN Legal business name | Ellner, Jerrold J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 8th, 2007 |
| Last updated | Feb 3rd, 2022 - about 2 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 | 1174736797 | NPPES |
| Massachusetts | MEDICAID | 110086419A | |
| Massachusetts | MEDICAID | 8201200 |
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