Healthcare Provider Details

I. General information

NPI: 1659309250
Provider Name (Legal Business Name): STANLEY Z. COWEN, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43845 10TH ST W #2A
LANCASTER CA
93534-4800
US

IV. Provider business mailing address

PO BOX 4478
CHATSWORTH CA
91313-4478
US

V. Phone/Fax

Practice location:
  • Phone: 818-709-8161
  • Fax: 818-709-8160
Mailing address:
  • Phone: 818-709-8161
  • Fax: 818-709-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG17178
License Number StateCA

VIII. Authorized Official

Name: DR. STANLEY Z COWEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-882-7730