Healthcare Provider Details

I. General information

NPI: 1164515623
Provider Name (Legal Business Name): IRWIN D COHEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 KELLY ST
HALF MOON BAY CA
94019
US

IV. Provider business mailing address

585 KELLY ST
HALF MOON BAY CA
94019-1719
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-3338
  • Fax: 650-560-9492
Mailing address:
  • Phone: 650-726-3338
  • Fax: 650-560-9492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE1610
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: