Individual
ELISA HENNESSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
250 DELAWARE AVE, SUITE 100, DELMAR, NY 12054-1420
(518) 439-8088
(518) 439-8070
Mailing address
711 TROY SCHENECTADY RD, SUITE 203, LATHAM, NY 12110-2442
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
016657
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03607976
—
NY
Enumeration date
07/08/2013
Last updated
09/10/2013
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