Provider Demographics
NPI:1356504625
Name:ELSENBECK, CYNTHIA (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ELSENBECK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 UNION MILLS RD
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-1972
Mailing Address - Country:US
Mailing Address - Phone:518-883-3395
Mailing Address - Fax:
Practice Address - Street 1:119 HOLLAND CIRCLE DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7550
Practice Address - Country:US
Practice Address - Phone:518-843-4552
Practice Address - Fax:518-843-8306
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY407357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY407357OtherNYS LICENSE #