Provider Demographics
NPI:1568738292
Name:ELLENHORN LLC
Entity Type:Organization
Organization Name:ELLENHORN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHYPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-491-2070
Mailing Address - Street 1:406 MASSCHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474
Mailing Address - Country:US
Mailing Address - Phone:617-491-2070
Mailing Address - Fax:
Practice Address - Street 1:406 MASSCHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474
Practice Address - Country:US
Practice Address - Phone:617-491-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty