Basic Information
Provider Information
NPI: 1922194521
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARES
FirstName: ELLA
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 GUSTAVE L LEVY PL # 1118
Address2:  
City: NEW YORK
State: NY
PostalCode: 100296504
CountryCode: US
TelephoneNumber: 2122410896
FaxNumber:  
Practice Location
Address1: 1111 AMSTERDAM AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100251716
CountryCode: US
TelephoneNumber: 2125238672
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/04/2006
LastUpdateDate: 06/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WD0400XF304133NYN Nursing Service ProvidersRegistered NurseDiabetes Educator
363LA2200XF304133-1NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LA2200XF304133NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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