Provider Demographics
NPI:1093972929
Name:HADDAD, ELLEN K (DO)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:K
Last Name:HADDAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:G
Other - Last Name:KRIMITSOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1991 MARCUS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2062
Mailing Address - Country:US
Mailing Address - Phone:516-466-4700
Mailing Address - Fax:516-466-4810
Practice Address - Street 1:1991 MARCUS AVE STE 110
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2062
Practice Address - Country:US
Practice Address - Phone:516-466-4700
Practice Address - Fax:516-466-4810
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2963432084N0400X
MS220392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology