Healthcare Provider Details

I. General information

NPI: 1396661682
Provider Name (Legal Business Name): YOSEF Y ELLENBOGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 2ND ST SW
ROCHESTER MN
55902-1906
US

IV. Provider business mailing address

920 6TH AVE SE
ROCHESTER MN
55904-5038
US

V. Phone/Fax

Practice location:
  • Phone: 416-857-7606
  • Fax:
Mailing address:
  • Phone: 416-857-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number82279
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: