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General NPI Number Information
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NPI Number | 1124932470
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Entity Type | Individual
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Provider Name | ELISSA ANNE FAHNESTOCK FNP
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Gender | Female
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 445 NEW KARNER RD
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City | ALBANY
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State | NY
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Zip | 12205-3809
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Country | US
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Telephone | 518-774-0945
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Fax |
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Provider Business Mailing Address
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Address Line | 35 SHAFER HEIGHTS RD
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City | GLEN SPEY
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State | NY
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Zip | 12737-6151
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Country | US
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Telephone | 518-774-0945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Anesthesiology) Physician
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License Number | F360775-01
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License Number State | NY
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