MEDICARE: DR. GARY L COHEN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	042857	NY

General Provider Information

NPI Number	:	1205054897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L COHEN DMD

Provider Business Mailing Address
First Line	:	30 E 30TH ST
Second Line	:	SUITE 1D
City	:	NEW YORK
State	:	NY
Zip	:	10016-7316
Country	:	US
Telephone Number	:	212-684-3794
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 E 30TH ST
Second Line	:	SUITE 1D
City	:	NEW YORK
State	:	NY
Zip	:	10016-7316
Country	:	US
Telephone Number	:	212-684-3794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	08/27/2008

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