MEDICARE: RAYMOND COGEN 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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	25MA06615900	NJ

General Provider Information

NPI Number	:	1578857066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND COGEN M.D.

Provider Business Mailing Address
First Line	:	72 GRANGE AVE
Second Line	:
City	:	FAIR HAVEN
State	:	NJ
Zip	:	07704-3004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 GRANGE AVE
Second Line	:
City	:	FAIR HAVEN
State	:	NJ
Zip	:	07704-3004
Country	:	US
Telephone Number	:	732-939-6299
Fax Number	:

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

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	06/02/2011

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