Provider Demographics
NPI:1558547034
Name:ELLIS HOSPITAL
Entity Type:Organization
Organization Name:ELLIS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-243-4141
Mailing Address - Street 1:1101 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2425
Mailing Address - Country:US
Mailing Address - Phone:518-243-1916
Mailing Address - Fax:518-243-1853
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-1916
Practice Address - Fax:518-243-1853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-15
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4601001H207P00000X, 207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRJ575OtherCDPHP
NYCI6804OtherRAILROAD MEDICARE
GRP417056001OtherBLUE SHIELD OF NENY
GRP417056001OtherBLUE SHIELD OF NENY