Enrique Ellenbogen, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

35100246 Issued in OH

Practice address

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

Phone

(937) 335-7121

Fax

(937) 335-7124

NPI assigned

Dec 1, 2006

Last updated

Jan 18, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326844800000",
    "number": "1972671709",
    "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": {
        "last_name": "ELLENBOGEN",
        "first_name": "ENRIQUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2012-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "35100246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L0277598",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000010310",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION NUMBER",
            "identifier": "311024334",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "D00246",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Njideka Jacintha Ejinaka, APRN
• Ifeoma Ekeh, M.D
• Fady Elassal
• Elighten Therapies LLC
• Elizabeth Township Board of Trustees
• Kimberly Eller
• Geri H Ellington, MA, LSW
• Meghan Elshoff, FNP
• Maria Fatima Elston
• Regina Embrador, PA-C

• Ophthalmology Physician in Troy, OH
• Providers in Troy, OH by specialty
• Ophthalmology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.