Provider Demographics
NPI:1518572882
Name:EHRENBERG, GEORGE W
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:EHRENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 MENTOR DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4650
Mailing Address - Country:US
Mailing Address - Phone:161-434-8230
Mailing Address - Fax:
Practice Address - Street 1:1434 MENTOR DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4650
Practice Address - Country:US
Practice Address - Phone:161-434-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health