Provider Demographics
NPI:1285892398
Name:KOTWAS-SONG, ELLEN LEAH (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:LEAH
Last Name:KOTWAS-SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:LEAH
Other - Last Name:KOTWAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-353-4344
Mailing Address - Fax:845-353-2661
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-353-4344
Practice Address - Fax:845-353-2661
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2459142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology