Provider Demographics
NPI:1184616096
Name:PEARSON, ELYSE S (MD)
Entity type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:S
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELYSE
Other - Middle Name:S
Other - Last Name:BRAUNSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170622207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E16855OtherAMERICAN PROGRESSIVE TODA
170622OtherTRICARE NORTH REGION
EP07K23910OtherEMPIRE BLUE CROSS
NY01078248Medicaid
040426006822OtherFIDELIS
17062255WOtherNO FAULT
904894OtherMVP
000913857002OtherBLUE SHIELD NENY
110160500OtherUS DEPT OF LABOR
9711926OtherGHI
CC6115OtherFIDELIS MEDICARE
000000084578OtherGHI HMO
10051759OtherCDPHP
17062255WOtherWORKERS COMP
EP07K23920OtherEMPIRE BLUE CROSS
170622OtherTRICARE NORTH REGION
17062255WOtherWORKERS COMP
9711926OtherGHI