Organization
ELLSWORTH MEDICAL, LLC
Active
Organization
ELLSWORTH MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN ALLAN COSKER JR. (OWNER)
(860) 431-4048
Entity
Organization
Contact information
Practice address
15 S MAIN ST STE B, EAST GRANBY, CT 06026-9550
(860) 431-4048
(860) 431-4058
Mailing address
15 S MAIN ST STE B, EAST GRANBY, CT 06026-9550
(860) 431-4048
(860) 431-4058
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004122149
—
CT
01
—
12DME0619CT02
ANTHEM BLUE CROSS
CT
Enumeration date
08/09/2006
Last updated
07/14/2026
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