Provider Demographics
NPI:1780770024
Name:BATTISTA, ELLEN B (NP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:BATTISTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 N FRENCH RD STE 7
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2100
Mailing Address - Country:US
Mailing Address - Phone:716-833-8184
Mailing Address - Fax:716-833-7176
Practice Address - Street 1:646 N FRENCH RD STE 7
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2100
Practice Address - Country:US
Practice Address - Phone:716-833-8184
Practice Address - Fax:716-833-7176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF38380633364SR0400X
NYF3838063364SR0400X
NY38380633363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010007802OtherUNIVERAHEALTH CARE
NY0005600706OtherCOMMUNITY BLUE
NY9512010OtherINDEPENDENT HEALTH
NY005600706OtherBLUE CROSS BLUE SHIELD
NYCC5503Medicare ID - Type Unspecified