Healthcare Provider Details

I. General information

NPI: 1558276493
Provider Name (Legal Business Name): ETHAN MEYER COHEN B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 NORTHWEST DR
PLAINVILLE CT
06062-1534
US

IV. Provider business mailing address

16 ROLLING MEADOW DR
WALLINGFORD CT
06492-2567
US

V. Phone/Fax

Practice location:
  • Phone: 860-793-3717
  • Fax:
Mailing address:
  • Phone: 203-294-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: