Provider Demographics
NPI:1598731754
Name:COHEN, ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4302
Mailing Address - Country:US
Mailing Address - Phone:201-217-1283
Mailing Address - Fax:
Practice Address - Street 1:17 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7601
Practice Address - Country:US
Practice Address - Phone:802-257-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA077497207R00000X
VT042.0014361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00923684Medicaid
NJ8985405Medicaid
NY00923684Medicaid
NJ8985405Medicaid
NYG400087683Medicare UPIN