Provider Demographics
NPI:1366566747
Name:ELWELL, JASON (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:ELWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RED JACKET ST
Mailing Address - Street 2:STONY BROOK PEDIATRICS
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 RED JACKET ST
Practice Address - Street 2:STONY BROOK PEDIATRICS
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9502
Practice Address - Country:US
Practice Address - Phone:585-335-5200
Practice Address - Fax:585-335-5037
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics