MEDICARE: COHEN DENTAL PC

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	040434-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396886313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHEN DENTAL PC

Provider Business Mailing Address
First Line	:	85 POMONA RD
Second Line	:
City	:	SUFFERN
State	:	NY
Zip	:	10901-1919
Country	:	US
Telephone Number	:	917-416-3681
Fax Number	:	845-331-8846

Provider Business Practice Location Address
First Line	:	186 BROADWAY
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-7707
Country	:	US
Telephone Number	:	845-331-9150
Fax Number	:	718-851-0240

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LESLIE COHEN
Credential	:	DDS
Telephone Number	:	917-416-3681

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	06/21/2020

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