Healthcare Provider Details

I. General information

NPI: 1497949622
Provider Name (Legal Business Name): ELLIS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 03/13/2018
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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6525110A
License Number StateNY

VIII. Authorized Official

Name: PAUL A MILTON
Title or Position: CEO
Credential:
Phone: 518-243-4000