Healthcare Provider Details

I. General information

NPI: 1114275112
Provider Name (Legal Business Name): COHN MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY RM 2350
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

PO BOX 1460
SUISUN CITY CA
94585-4460
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4738
  • Fax: 510-204-5892
Mailing address:
  • Phone: 510-964-0458
  • Fax: 510-964-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA110257
License Number StateCA

VIII. Authorized Official

Name: MS. JENNIFER AMICA COHN
Title or Position: OWNER
Credential: M.D.
Phone: 510-964-0458