Provider Demographics
NPI:1023187135
Name:COHEN, ELLEN
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-645-0111
Mailing Address - Fax:860-635-3923
Practice Address - Street 1:621 FARMINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-233-9990
Practice Address - Fax:860-233-9990
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice