Healthcare Provider Details

I. General information

NPI: 1558477596
Provider Name (Legal Business Name): ELLEN MARIE BIGGERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NORTH PARK STREET
CAMBRIDGE NY
12816
US

IV. Provider business mailing address

22 NORTH PARK STREET APT #2
CAMBRIDGE NY
12816
US

V. Phone/Fax

Practice location:
  • Phone: 518-677-7882
  • Fax: 518-677-5392
Mailing address:
  • Phone: 518-677-7882
  • Fax: 518-677-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number185142
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number042-0009970
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: