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NPI Code Detail

MEDICARE: DR. RUSSELL W COHEN M.D.

MEDICARE: DR. RUSSELL W COHEN M.D.
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
1207N00000XDermatology Physician16709-1NY

General Provider Information

NPI Number : 1538167242
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL W COHEN M.D.
Provider Business Mailing Address
First Line : 258 MERRICK RD
Second Line :
City : OCEANSIDE
State : NY
Zip : 11572-1427
Country : US
Telephone Number : 516-766-0345
Fax Number : 516-255-5353
Provider Business Practice Location Address
First Line : 258 MERRICK RD
Second Line :
City : OCEANSIDE
State : NY
Zip : 11572-1427
Country : US
Telephone Number : 516-766-0345
Fax Number : 516-255-5353
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 04/07/2010

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