Individual
BENJAMIN G. ELLENBOGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45185 ONONDAGA DR, FREMONT, CA 94539-6739
(510) 659-8182
Mailing address
45185 ONONDAGA DR, FREMONT, CA 94539-6739
(510) 659-8182
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G46961
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G469610
—
CA
Enumeration date
11/01/2006
Last updated
02/01/2012
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