DR. ELLIS ENABOSI (NPI# 1669866158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669866158 |
| Entity Type | Individual |
| Full Name | DR. ELLIS ENABOSI |
| Credential | M.D. |
| Practice Address |
455 Jersey St Staten Island NY 10301-2976 |
| Mailing Address |
3198 Grand Concourse Bronx NY 10458-1000 |
| Practice Telephone | 1875245611 |
| Mailing Telephone | 7186180401 |
| Mailing Fax Number | 3474791303 |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2019-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 291470 | NY | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 291470 | NY | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2015 Grand Concourse, Bronx, NY 104534303 | 7182997295 | 7186186797 |
| 460 N Maple Ave, East Orange, NJ 070174619 | 9732809600 |
| Street Address |
455 JERSEY ST |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10301-2976 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437784493 | Nicole Rodriguez Taranto | Nurse Practitioner | 455 Jersey St, Staten Island, NY 10301-2976 | 2020-03-10 |
| 1508413097 | Progressive Medical Pllc | Internal Medicine | 455 Jersey St, Staten Island, NY 10301-2976 | 2019-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417586397 | Maria Duncan | Registered Nurse | Nurse Family Partnership, 358 St. Marks Place, 5th Floor, Staten Island, NY 10301 | 2020-04-03 |
| 1659835569 | Ipark Podiatry P.C. | Podiatrist | 970 Bard Avenue, Staten Island, NY 10301 | 2019-01-24 |
| 1386149789 | Dana Gioia | Specialist | 215 Hart Blvd Apt 5a, Staten Island, NY 10301 | 2018-03-27 |
| 1710404850 | Physical Therapy Unlimited | Preferred Provider Organization | 684 Ocean Terrace, Staten Island, NY 10301 | 2017-08-29 |
| 1356885438 | Jessica Glassman | Social Worker | 10 Dobbs Pl, Staten Island, NY 10301 | 2016-12-08 |
| 1679016372 | Amelia Rella | Speech-Language Pathologist | 60 Foote Ave, Staten Island, NY 10301 | 2016-11-29 |
| 1457714958 | Philip Kaplan | Dentist | 155 Bay Street, Unit C3, Staten Island, NY 10301 | 2016-04-01 |
| 1104284777 | Marie G Joseph | Social Worker | 2381 Hyland Blvd, Staten Island, NY 10301 | 2016-02-10 |
| 1700262565 | Courtney Pryor | Speech-Language Pathologist | 57 Westbury Avenue, Staten Island, NY 10301 | 2015-08-04 |
| 1710377999 | Jessica Maldarelli | Speech-Language Pathologist | 91 Henderson Avenue, Staten Island, NY 10301 | 2015-01-27 |
| Find all providers in zip 10301 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700404720 | Medical Doctor Milena Kolesnikova PC | Internal Medicine | 586 Midland Ave Ste B, Staten Island, NY 10306-5903 | 2020-07-07 |
| 1962913459 | Vaithilingam Arulthasan Md PC | Internal Medicine | 57 Andes Pl, Staten Island, NY 10314-5524 | 2017-10-24 |
| 1306384839 | Nazar Sharak | Internal Medicine | 7 Father Capodanno Blvd, Staten Island, NY 10305-4801 | 2017-02-03 |
| 1326494485 | Syed Shahab Kazmi | Internal Medicine | 355 Bard Ave Dept of Medicine Villa Building, 1st Floor, Staten Island, NY 10310-1664 | 2016-05-09 |
| 1114380383 | Crown Neurology, P.C. | Internal Medicine | 1181 Woodrow Rd, Staten Island, NY 10309-1723 | 2016-04-04 |
| 1114386265 | Maryline Shang Nformi | Internal Medicine | 355 Bard Avenue, Dep't of Medicine Villa B'dg 1st Floor, Staten Island, NY 10310-1664 | 2016-02-17 |
| 1639557382 | Charles Sineri | Internal Medicine | 104 Nashville St, Staten Island, NY 10307-1325 | 2015-05-14 |
| 1780086363 | Prr Diagnostic Medicine PC | Internal Medicine | 1265 Clove Rd, Staten Island, NY 10301-4339 | 2014-09-25 |
| 1689088403 | Ashraf Saad Dwal | Internal Medicine | 355 Bard Ave Dept Of, Villa Bldg 1st Floor, Staten Island, NY 10310 | 2014-06-19 |
| 1538590161 | Borislav Kheyson | Internal Medicine | 596 Ramona Ave, Staten Island, NY 10309-2223 | 2013-12-08 |
| Find all providers in STATEN ISLAND | ||||
| City | STATEN ISLAND |
| Zip Code | 10301 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.