Organization
ENRIQUE ELLENBOGEN, M.D. INC
Active
Other names
Ellenbogen Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA JEAN ZIMMERMAN (OFFICE MANAGER)
(937) 335-7121
Entity
Organization
Contact information
Practice address
700 S STANFIELD RD, SUITE B, TROY, OH 45373-2569
(937) 335-7121
(937) 335-7124
Mailing address
700 S STANFIELD RD, SUITE B, TROY, OH 45373-2569
(937) 335-7121
(937) 335-7124
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
35100246
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000010310
ANTHEM
OH
01
—
D00246
HUMANA
OH
05
—
L0277598
—
OH
Enumeration date
08/11/2008
Last updated
08/22/2008
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