Provider Demographics
NPI:1134132723
Name:DEPREY, ELLEN M (RPA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:DEPREY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:126 SKI BOWL RD
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853-2607
Practice Address - Country:US
Practice Address - Phone:518-251-2541
Practice Address - Fax:518-251-3055
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02346789Medicaid
NY02346789Medicaid