Healthcare Provider Details

I. General information

NPI: 1639707037
Provider Name (Legal Business Name): MS. ELIZABETH TENNEY-DOMANSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 RHINEBECK RD
COBLESKILL NY
12043-6503
US

IV. Provider business mailing address

281 RHINEBECK RD
COBLESKILL NY
12043-6503
US

V. Phone/Fax

Practice location:
  • Phone: 518-530-7900
  • Fax:
Mailing address:
  • Phone: 518-530-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number682523
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF348319-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: