Provider Demographics
NPI:1053376335
Name:HEY, ELLEN M (NP)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:HEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-0423
Mailing Address - Country:US
Mailing Address - Phone:315-531-9102
Mailing Address - Fax:315-531-9103
Practice Address - Street 1:117 E STEUBEN ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1636
Practice Address - Country:US
Practice Address - Phone:607-776-3063
Practice Address - Fax:607-776-1011
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334123-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP0644OtherPREFERRED CARE
NY02565653Medicaid
NYP019334123OtherBLUE CHOICE
NY02565653Medicaid
NYNP0644OtherPREFERRED CARE