Individual
JACK ELLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
239 CENTRAL PARK W, NEW YORK, NY 10024-6038
(212) 873-1291
(212) 799-1136
Mailing address
239 CENTRAL PARK W, NEW YORK, NY 10024-6038
(212) 873-1291
(212) 799-1136
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
089526
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00140496
—
NY
Enumeration date
10/03/2006
Last updated
08/31/2012
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