Provider Demographics
NPI:1063500536
Name:COHEN, KENNETH LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEROY
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:LEROY
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:950 CAMPBELL AVE
Mailing Address - Street 2:EMERGENCY ROOM/11C
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2770
Mailing Address - Country:US
Mailing Address - Phone:203-937-4777
Mailing Address - Fax:203-937-4854
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:EMERGENCY ROOM/11C
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-937-4777
Practice Address - Fax:203-937-4854
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine