Provider Demographics
NPI:1861153884
Name:ELOISE PALMISANO RN NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:ELOISE PALMISANO RN NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:PALMISANO RN
Authorized Official - Last Name:NPP
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:518-741-6111
Mailing Address - Street 1:268 BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4271
Mailing Address - Country:US
Mailing Address - Phone:518-741-6111
Mailing Address - Fax:518-450-1052
Practice Address - Street 1:268 BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4271
Practice Address - Country:US
Practice Address - Phone:518-741-6111
Practice Address - Fax:518-450-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPRC200212771OtherCDPHP
NY03321004Medicaid