Provider Demographics
NPI:1356347090
Name:KOSLO, ELLEN (AUD CCC-A)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:KOSLO
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 W 43RD ST
Mailing Address - Street 2:APT 26M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6329
Mailing Address - Country:US
Mailing Address - Phone:212-947-1026
Mailing Address - Fax:212-305-3264
Practice Address - Street 1:CUMC 622 W168TH STREET VC 10 AREA D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-6428
Practice Address - Fax:212-305-3264
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001207-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist