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1659907103
JUSTIN ELLENBERG
FARMINGTON, CT
NPI
1659907103
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2020-03-17
Last Update Date
2021-03-26
Business Address
JUSTIN ELLENBERG
263 FARMINGTON AVE # LG065
FARMINGTON, CT 06030-1956
Phone number: 860-679-4988
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Mailing Address
JUSTIN ELLENBERG
263 FARMINGTON AVE
FARMINGTON, CT 06030-1921
Phone number: 860-679-2147
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