Individual
JEFFREY M ELLENBOGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 FRUIT STREET, WANG 720 (NEUROLOGY), BOSTON, MA 02114
(617) 724-7419
Mailing address
60 WHITE OAK RD, NEWTON, MA 02468-1323
(617) 724-7419
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
226436
MA
Other
Enumeration date
06/06/2006
Last updated
11/16/2012
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