Healthcare Provider Details

I. General information

NPI: 1417936139
Provider Name (Legal Business Name): JONATHAN COSIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HART ST BUILDING D
NEW BRITAIN CT
06052-1743
US

IV. Provider business mailing address

40 HART ST BUILDING D
NEW BRITAIN CT
06052-1743
US

V. Phone/Fax

Practice location:
  • Phone: 860-826-1101
  • Fax:
Mailing address:
  • Phone: 860-826-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number51253
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: