Provider Demographics
NPI:1023230018
Name:ELLIS, ROBIN SAMUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:SAMUEL
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W. 72ND STREET
Mailing Address - Street 2:APT. 20D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4166
Mailing Address - Country:US
Mailing Address - Phone:212-496-6397
Mailing Address - Fax:212-595-1797
Practice Address - Street 1:243 WEST END AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-595-1100
Practice Address - Fax:212-595-1797
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0423621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics