NICOLE DANIELLE ELLENBOGEN
NPI 1174369201
Physician Assistant - Medical in New York, NY

Active since July 08, 2024PECOS EnrolledAccepts Medicare Assignment
100 E 77TH ST, NEW YORK, NY 10075(212) 434-2000 Get Directions Write a Review

NPPES record last updated: July 15, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 15, 2024, Jul 8, 2024 (2 updates tracked since 2024).

About Nicole Danielle Ellenbogen NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE DANIELLE ELLENBOGEN (NPI 1174369201) is an individual medical provider in New York, New York and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1174369201
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameNICOLE DANIELLE ELLENBOGEN
Location Address100 E 77TH STNew York, NY 10075-1850
Mailing Address761 Downing StTeaneck, NJ 07666-2221 · (201) 546-4770
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateJuly 8, 2024
Last NPPES UpdateJuly 15, 20242 updates tracked since enumeration
NPPES CertifiedJuly 15, 2024
NPI 1174369201 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
100 E 77TH ST, New York, NY 10075

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Nicole Danielle Ellenbogen is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5597293449
PECOS Enrollment IDI20250107000095
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Neonatal, Critical Care)
100 E 77TH ST
NEW YORK, NY 10075
Physician Assistant
100 E 77TH ST
NEW YORK, NY 10075
Student in an Organized Health Care Education/Training Program
100 E 77TH ST
NEW YORK, NY 10075
Student in an Organized Health Care Education/Training Program
100 E 77TH ST
NEW YORK, NY 10075
Student in an Organized Health Care Education/Training Program
100 E 77TH ST
NEW YORK, NY 10075
Physician Assistant
100 E 77TH ST
NEW YORK, NY 10075
Anesthesiology
100 E 77TH ST
NEW YORK, NY 10075
Nurse Practitioner (Acute Care)
100 E 77TH ST
NEW YORK, NY 10075

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Ellenbogen's NPI number?

The NPI number for Nicole Ellenbogen is 1174369201. It was assigned to this individual provider in the NPPES registry on July 8, 2024.

Where is Nicole Ellenbogen located?

Nicole Ellenbogen practices at 100 E 77th St, New York, NY 10075. The listed phone number is (212) 434-2000.

What is Nicole Ellenbogen's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Nicole Ellenbogen enrolled in Medicare?

Yes. Nicole Ellenbogen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Nicole Ellenbogen was last updated on July 15, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.