Provider Demographics
NPI:1396058616
Name:ECKES, EMILY TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:TAYLOR
Last Name:ECKES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:121 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1474
Mailing Address - Country:US
Mailing Address - Phone:518-489-2663
Mailing Address - Fax:518-689-3881
Practice Address - Street 1:500 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2414
Practice Address - Country:US
Practice Address - Phone:518-489-2663
Practice Address - Fax:518-689-3881
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003310363AS0400X
NY017689363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101180Medicaid
NY04017992Medicaid
VA1396058616Medicaid
VAPAROtherUSA MANAGED CARE
VA-019OtherTRICARE/CHAMPUS
VA1396058616Medicaid
NC8101180Medicaid
NY017689OtherNY LICENSE
NY04017992Medicaid
VAPAROtherMULTIPLAN
NY017689OtherNY LICENSE