Healthcare Provider Details

I. General information

NPI: 1760827166
Provider Name (Legal Business Name): COHEN DERMATOPATHOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE SUITE 332
FARMINGTON CT
06032-1934
US

IV. Provider business mailing address

6655 NORTH MACARTHUR BOULEVARD ATTN: MANAGED CARE DEPARTMENT
IRVING TX
75039-2443
US

V. Phone/Fax

Practice location:
  • Phone: 617-969-4100
  • Fax:
Mailing address:
  • Phone: 214-596-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BONNIE SUE PIRTZ
Title or Position: VP, MANAGED CARE
Credential:
Phone: 480-309-2674