Provider Demographics
NPI:1659689834
Name:BRIGNOLA, ELLEN A (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:A
Last Name:BRIGNOLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TALLOW WOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-373-4444
Mailing Address - Fax:518-373-0663
Practice Address - Street 1:1 TALLOW WOOD DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2807
Practice Address - Country:US
Practice Address - Phone:518-373-4444
Practice Address - Fax:518-373-0663
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336354363L00000X
NYF336354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03263650Medicaid
NY644141OtherGHI/HMO
NY3014370OtherMVP HEALTHCARE
NY307090OtherSENIOR WHOLE HEALTH
NY101209000118OtherFIDELIS
NY3014370OtherMVP HEALTHCARE
NYJ400030484Medicare PIN