Healthcare Provider Details

I. General information

NPI: 1558547034
Provider Name (Legal Business Name): ELLIS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST
SCHENECTADY NY
12308-2425
US

IV. Provider business mailing address

1101 NOTT ST
SCHENECTADY NY
12308-2425
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-1916
  • Fax: 518-243-1853
Mailing address:
  • Phone: 518-243-1916
  • Fax: 518-243-1853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4601001H
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4601001H
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4601001H
License Number StateNY

VIII. Authorized Official

Name: PAUL A MILTON
Title or Position: CEO
Credential:
Phone: 518-243-4141