Individual
NICOLE DANIELLE ELLENBOGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E 77TH ST, NEW YORK, NY 10075-1850
(212) 434-2000
Mailing address
761 DOWNING ST, TEANECK, NJ 07666-2221
(201) 546-4770
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
07/08/2024
Last updated
07/15/2024
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