Healthcare Provider Details

I. General information

NPI: 1578560132
Provider Name (Legal Business Name): ELLEN BLOCK MILSTONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 WHITNEY AVE
HAMDEN CT
06518-3248
US

IV. Provider business mailing address

2416 WHITNEY AVE
HAMDEN CT
06518-3248
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-1142
  • Fax: 203-288-5086
Mailing address:
  • Phone: 203-288-1142
  • Fax: 203-288-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number017267
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number017267
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number017267
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number017267
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: