Healthcare Provider Details

I. General information

NPI: 1255713178
Provider Name (Legal Business Name): ELENA KOCHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PARK AVE
HARRISON NY
10528-4414
US

IV. Provider business mailing address

373 MAIN ST UNIT B
NEW CANAAN CT
06840-5903
US

V. Phone/Fax

Practice location:
  • Phone: 914-575-9362
  • Fax:
Mailing address:
  • Phone: 914-575-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: