MEDICARE: MR. MARSHALL ALLEN COHEN BS

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	183500000X	Pharmacist	026211	NY

General Provider Information

NPI Number	:	1730403932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARSHALL ALLEN COHEN BS

Provider Business Mailing Address
First Line	:	14 KINGS MILL RD
Second Line	:
City	:	MONROE TOWNSHIP
State	:	NJ
Zip	:	08831-8902
Country	:	US
Telephone Number	:	609-235-9390
Fax Number	:

Provider Business Practice Location Address
First Line	:	2758 GERRITSEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5915
Country	:	US
Telephone Number	:	718-332-7155
Fax Number	:

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

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	03/17/2010

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