Provider Demographics
NPI:1821098047
Name:EHRENBERG, MITCHELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:EHRENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MONROE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1311
Mailing Address - Country:US
Mailing Address - Phone:585-385-3372
Mailing Address - Fax:585-385-2836
Practice Address - Street 1:61 MONROE AVE STE A
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1311
Practice Address - Country:US
Practice Address - Phone:585-385-3372
Practice Address - Fax:585-385-2836
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01242520Medicaid
NY01242520Medicaid
NYP010175142OtherBLUE CHOICE #
NY5191153OtherAETNA
NY101248BJOtherPREFERRED CARE
NY11713CMedicare ID - Type Unspecified