Healthcare Provider Details

I. General information

NPI: 1164586145
Provider Name (Legal Business Name): ALLISON V COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PECK ST
NORTH HAVEN CT
06473-2308
US

IV. Provider business mailing address

13 PECK ST
NORTH HAVEN CT
06473-2308
US

V. Phone/Fax

Practice location:
  • Phone: 203-239-4627
  • Fax: 203-234-8533
Mailing address:
  • Phone: 203-239-4627
  • Fax: 203-234-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041973
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: