Healthcare Provider Details

I. General information

NPI: 1285636498
Provider Name (Legal Business Name): KENNETH A COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 SAND PIT RD STE 207
DANBURY CT
06810-4015
US

IV. Provider business mailing address

73 SAND PIT RD STE 207
DANBURY CT
06810-4015
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-4151
  • Fax: 203-792-4155
Mailing address:
  • Phone: 203-792-4151
  • Fax: 203-792-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number027310
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: