Provider Demographics
NPI:1942745831
Name:ELLIS HOSPITAL
Entity Type:Organization
Organization Name:ELLIS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-347-5320
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:518-347-5315
Mailing Address - Fax:518-382-2353
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-347-5315
Practice Address - Fax:518-382-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY460100111282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital