Healthcare Provider Details

I. General information

NPI: 1710080619
Provider Name (Legal Business Name): LEONARD COHEN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 FARMINGTON AVE
WEST HARTFORD CT
06107-2227
US

IV. Provider business mailing address

928 FARMINGTON AVE
WEST HARTFORD CT
06107-2227
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-6293
  • Fax:
Mailing address:
  • Phone: 860-233-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number023307
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: