Individual
JUSTIN ELLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
263 FARMINGTON AVE # LG065, FARMINGTON, CT 06030-1956
(860) 679-4988
(860) 679-3489
Mailing address
263 FARMINGTON AVE, FARMINGTON, CT 06030-1921
(860) 679-2147
(860) 679-4624
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CT
Other
Enumeration date
03/17/2020
Last updated
03/26/2021
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