MEDICARE: MR. NEIL JAY COHEN

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1770080012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEIL JAY COHEN

Provider Business Mailing Address
First Line	:	422 FARNSWORTH CIR
Second Line	:
City	:	PORT BARRINGTON
State	:	IL
Zip	:	60010-1082
Country	:	US
Telephone Number	:	224-268-5991
Fax Number	:

Provider Business Practice Location Address
First Line	:	422 FARNSWORTH CIR
Second Line	:
City	:	PORT BARRINGTON
State	:	IL
Zip	:	60010-1082
Country	:	US
Telephone Number	:	224-268-5991
Fax Number	:

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	04/12/2018

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Directions to “ MR. NEIL JAY COHEN ” Practice Location

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