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General NPI Number Information
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NPI Number | 1699855619
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Entity Type | Individual
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Provider Name | ELISE DE MD
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | SOUTH CLINICAL CAMPUS 23 HACKETT BLVD. (MC 208)
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City | ALBANY
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State | NY
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Zip | 12208
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Country | US
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Telephone | 518-262-3341
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Fax |
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Provider Business Mailing Address
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Address Line | 25 HACKETT BOULEVARD ALBANY MED UROLOGY MC208
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City | ALBANY
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State | NY
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Zip | 12208
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Country | US
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Telephone | 518-262-3341
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Fax | 518-262-6660
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 236214
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License Number State | NY
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