Active NPI
Ellen Supinski, MSED
- Specialist
- Keeseville, NY
National Provider Identifier
1952841702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 635691931
- Practice address
- 1701 Front Street
Keeseville, NY 12944 - Phone
- (518) 572-9794
- NPI assigned
- Feb 27, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 635691931 | NY | Primary |
Addresses
Primary practice location
1701 Front Street
Keeseville, NY 12944
Mailing address
PO Box 695
Dannemora, NY 12929-0695
Phone (518) 572-9794
Other names 1
- Ellen Fraser
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 635691931 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488153600000",
"number": "1952841702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 695",
"city": "DANNEMORA",
"state": "NY",
"postal_code": "129290695",
"telephone_number": "518-572-9794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 FRONT STREET",
"city": "KEESEVILLE",
"state": "NY",
"postal_code": "12944",
"telephone_number": "518-572-9794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPINSKI",
"first_name": "ELLEN",
"credential": "MSED",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-27",
"last_updated": "2017-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "635691931",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELLEN",
"last_name": "FRASER",
"credential": "MSED",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Keeseville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.