Provider Demographics
NPI:1124073135
Name:JOFFE, ELLEN JEAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:JEAN
Last Name:JOFFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:JEAN
Other - Last Name:DUBILIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-895-1995
Practice Address - Fax:502-895-6479
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA005363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS46868Medicare UPIN
KY0968603Medicare ID - Type Unspecified