Provider Demographics
NPI:1871814699
Name:SOFFIN, ELLEN M (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:SOFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:COSSANZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:PO BOX 27578
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7578
Mailing Address - Country:US
Mailing Address - Phone:631-329-6925
Mailing Address - Fax:631-329-6925
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY, HOSPITAL FOR SPECIAL SURG
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4823
Practice Address - Country:US
Practice Address - Phone:212-690-6103
Practice Address - Fax:212-517-4481
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276749207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04260697Medicaid
NYA400131176Medicare PIN