MEDICARE: ELLEN M DEPREY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	005185	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134132723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN M DEPREY PA-C

Provider Business Mailing Address
First Line	:	9 CAREY RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-7880
Country	:	US
Telephone Number	:	518-761-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 SKI BOWL RD
Second Line	:
City	:	NORTH CREEK
State	:	NY
Zip	:	12853-2607
Country	:	US
Telephone Number	:	518-251-2541
Fax Number	:	518-251-3055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/31/2025

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