Enrique Ellenbogen, M.D. Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

35100246 Issued in OH

Legal business name

ENRIQUE ELLENBOGEN, M.D. INC

Practice address

700 S Stanfield Rd
Suite B
Troy, OH 45373-2569

Phone

(937) 335-7121

Fax

(937) 335-7124

NPI assigned

Aug 11, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Donna Jean Zimmerman

Title

Office Manager

Phone

(937) 335-7121

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Ellenbogen Eye Center Other name

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

{
    "created_epoch": "1218412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219363200000",
    "number": "1184870164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S STANFIELD RD",
            "address_2": "SUITE B",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453732569",
            "telephone_number": "937-335-7121",
            "fax_number": "937-335-7124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S STANFIELD RD",
            "address_2": "SUITE B",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453732569",
            "telephone_number": "937-335-7121",
            "fax_number": "937-335-7124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENRIQUE ELLENBOGEN, M.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-11",
        "last_updated": "2008-08-22",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "937-335-7121",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OH",
            "license": "35100246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "D00246",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L0277598",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000010310",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellenbogen Eye Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinic/Center in Troy, OH
• Providers in Troy, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.