Healthcare Provider Details

I. General information

NPI: 1548763493
Provider Name (Legal Business Name): ELLIS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 STATE ST
SCHENECTADY NY
12307-1511
US

IV. Provider business mailing address

1023 STATE ST
SCHENECTADY NY
12307-1511
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-3300
  • Fax: 518-377-9151
Mailing address:
  • Phone: 518-243-3300
  • Fax: 518-377-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNY

VIII. Authorized Official

Name: JULIE SLOVER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 518-347-5400