Healthcare Provider Details

I. General information

NPI: 1245313493
Provider Name (Legal Business Name): ELIN R COHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN R COHEN MD

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GOODHILL RD
WESTON CT
06883
US

IV. Provider business mailing address

5 FIELDSTONE DR
EASTON CT
06612
US

V. Phone/Fax

Practice location:
  • Phone: 203-226-3035
  • Fax: 203-221-1736
Mailing address:
  • Phone: 203-261-2019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037492
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number037492
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: