Healthcare Provider Details

I. General information

NPI: 1215928148
Provider Name (Legal Business Name): ELLIS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MCCLELLAN ST
SCHENECTADY NY
12304-1009
US

IV. Provider business mailing address

600 MCCLELLAN ST
SCHENECTADY NY
12304-1009
US

V. Phone/Fax

Practice location:
  • Phone: 518-382-2250
  • Fax: 518-382-2206
Mailing address:
  • Phone: 518-382-2250
  • Fax: 518-382-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4601001N
License Number StateNY

VIII. Authorized Official

Name: MR. JAMES CONNOLLY
Title or Position: CEO
Credential:
Phone: 518-243-4141