Individual
ELISE DE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
SOUTH CLINICAL CAMPUS, 23 HACKETT BLVD. (MC 208), ALBANY, NY 12208
(518) 262-3341
Mailing address
25 HACKETT BOULEVARD, ALBANY MED UROLOGY MC208, ALBANY, NY 12208
(518) 262-3341
(518) 262-6660
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
236214
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02662164
—
NY
Enumeration date
10/16/2006
Last updated
02/04/2025
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