Provider Demographics
NPI:1699855619
Name:DE, ELISE (MD)
Entity type:Individual
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First Name:ELISE
Middle Name:
Last Name:DE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:25 HACKETT BOULEVARD
Mailing Address - Street 2:ALBANY MED UROLOGY MC208
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-262-3341
Mailing Address - Fax:518-262-6660
Practice Address - Street 1:SOUTH CLINICAL CAMPUS
Practice Address - Street 2:23 HACKETT BLVD. (MC 208)
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-262-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-02-04
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Provider Licenses
StateLicense IDTaxonomies
NY236214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02662164Medicaid
NYRB5979Medicare PIN
NYRA7454Medicare PIN
NYI35610Medicare UPIN