Provider Demographics
NPI:1538745336
Name:ELLISON, ANDREW (PA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ELLISON
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Gender:M
Credentials:PA
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Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-232-2980
Mailing Address - Fax:585-232-6552
Practice Address - Street 1:995 SENATOR KEATING BLVD STE 330
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2779
Practice Address - Country:US
Practice Address - Phone:585-232-2980
Practice Address - Fax:585-232-6552
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-09-24
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Provider Licenses
StateLicense IDTaxonomies
NY026863363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical