Healthcare Provider Details

I. General information

NPI: 1437709821
Provider Name (Legal Business Name): GERALD COHEN DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W ELM ST
GREENWICH CT
06830-6425
US

IV. Provider business mailing address

40 W ELM ST
GREENWICH CT
06830-6425
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD COHEN
Title or Position: OWNER
Credential: DDS
Phone: 203-869-2651