Jack Ellenberg, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

089526 Issued in NY

Practice address

239 Central Park W
New York, NY 10024-6038

Phone

(212) 873-1291

Fax

(212) 799-1136

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346371200000",
    "number": "1790879013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 CENTRAL PARK W",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100246038",
            "telephone_number": "212-873-1291",
            "fax_number": "212-799-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 CENTRAL PARK W",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100246038",
            "telephone_number": "212-873-1291",
            "fax_number": "212-799-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBERG",
        "first_name": "JACK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2012-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "089526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00140496",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellen C. Gendler, M.D., P.C.
• Ellen M Buchbinder MD PC
• Ellen M Rooney MD PC
• Ellen Mellow MD, PLLC
• Nicole M Ellen, P.T.
• 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

• Psychiatry Physician in New York, NY
• Providers in New York, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; 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.