Provider Demographics
NPI:1699112359
Name:NELLIS, ERIC
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:NELLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CEDAR CREST BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2309
Mailing Address - Country:US
Mailing Address - Phone:610-821-2828
Mailing Address - Fax:610-821-7915
Practice Address - Street 1:1501 N CEDAR CREST BLVD STE 110
Practice Address - Street 2:EASTERN PENNSYLVANIA GASTROENTEROLOGY AND LIVER SPECIAL
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2309
Practice Address - Country:US
Practice Address - Phone:215-707-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT204302207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology