Nicole Danielle Ellenbogen

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

100 E 77TH St
New York, NY 10075-1850

Phone

(212) 434-2000

NPI assigned

Jul 8, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: nellenbogen69278@northwell.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group
• North Shore - Lij Medical PC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1174369201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 DOWNING ST",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076662221",
            "telephone_number": "201-546-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751850",
            "telephone_number": "212-434-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBOGEN",
        "first_name": "NICOLE",
        "middle_name": "DANIELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Rachel Ellenberg, O.D.
• Luke Grisha Ellenberg, C.A.S.A.C.
• Amy Abigail Ellenbogen, M.S.W.
• Donna Elise Ellenbogen
• Glenn C. Ellenbogen
• Lora Ellenson, M.D.
• Alexandra Eller
• Christina Eller, LMHC MSED
• Melinda Eller, PA-C
• Alice T Ellerbeck, LMSW

• Medical Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.