Basic Information
| Provider Information | |||||||||
| NPI: | 1235289422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOKEY | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1240 NEW SCOTLAND RD | ||||||||
| Address2: | |||||||||
| City: | SLINGERLANDS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121599222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184757000 | ||||||||
| FaxNumber: | 5184757050 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PATROON CREEK BLVD STE 1 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122065014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184890044 | ||||||||
| FaxNumber: | 5184893591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 303985 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 02571204 | 05 | NY | MEDICAID |