Provider Demographics
NPI:1891953220
Name:ELLEN COHEN
Entity Type:Organization
Organization Name:ELLEN COHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:845-634-6207
Mailing Address - Street 1:60 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3542
Mailing Address - Country:US
Mailing Address - Phone:845-634-6207
Mailing Address - Fax:
Practice Address - Street 1:60 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3542
Practice Address - Country:US
Practice Address - Phone:845-634-6207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27800302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization