| Ellis Hospital | |
| 
					115 Saratoga Rd Ste 200 Glenville NY 12302-4224  | |
| (518) 243-3360 | |
| Not Available | 
| Full Name | Ellis Hospital | 
|---|---|
| Speciality | Clinic/center - Primary Care | 
| Location | 115 Saratoga Rd Ste 200, Glenville, New York | 
| Authorized Official Name and Position | Paul A Milton (CEO) | 
| Authorized Official Contact | 5182434175 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Ellis Hospital 115 Saratoga Rd Ste 200 Glenville NY 12302-4224 Ph: (518) 243-3360  | Ellis Hospital 115 Saratoga Rd Ste 200 Glenville NY 12302-4224 Ph: (518) 243-3360  | 
| NPI Number | 1548740848 | 
|---|---|
| Provider Enumeration Date | 08/16/2018 | 
| Last Update Date | 08/16/2018 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1548740848 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 4601001H (New York) | Primary | 
Lauris J. Petersen Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15 Glenridge Rd, Glenville, NY 12302 Phone: 518-399-0909 Fax: 518-399-2640  |