Healthcare Provider Details

I. General information

NPI: 1730199852
Provider Name (Legal Business Name): ELLSWORTH MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S MAIN ST STE B
EAST GRANBY CT
06026-9550
US

IV. Provider business mailing address

15 S MAIN ST STE B
EAST GRANBY CT
06026-9550
US

V. Phone/Fax

Practice location:
  • Phone: 860-431-4048
  • Fax: 860-431-4058
Mailing address:
  • Phone: 860-431-4048
  • Fax: 860-431-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN ALLAN COSKER JR.
Title or Position: OWNER
Credential:
Phone: 860-431-4048