=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396984159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC R COHEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2009
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 263 FARMINGTON AVE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-679-2784
-----------------------------------------------------
Fax | 860-679-3145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1044 BELMONT AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44504-1006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-480-2502
-----------------------------------------------------
Fax | 330-480-8609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 35.132528
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | 35.132528
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 068199
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------