MEDICARE: ELISSA GRANATA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F357900-01	NY

General Provider Information

NPI Number	:	1710854641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA GRANATA APRN

Provider Business Mailing Address
First Line	:	9 LUCKY LN
Second Line	:
City	:	WASHINGTONVILLE
State	:	NY
Zip	:	10992-1815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 ROUTE 312 STE 201
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-2338
Country	:	US
Telephone Number	:	845-278-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2025
Last Update Date	:	11/14/2025

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