Most Relevant Information
Provider Data
| NPI Number: | 1003497652 |
| Provider Name: | JARROD THOMAS ELLIS |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/15/2021 |
| Last Updated: | 04/15/2021 |
Provider Practice Location
750 E ADAMS ST
SYRACUSE
NY
132102306
Practice Location Phone/Fax
| Phone: | 3154646635 |
| Fax: |
Provider Mailing Location
136 LAKEVIEW DR
MC KEES ROCKS
PA
151361233
Provider Mailing Phone/Fax
| Phone: | 4129264634 |
| Fax: |