Healthcare Provider Details

I. General information

NPI: 1588676365
Provider Name (Legal Business Name): IVAN COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 CHAPMAN RD BELLEVUE BLDG. SUITE 100
NEWARK DE
19702-5448
US

IV. Provider business mailing address

262 CHAPMAN RD BELLEVUE BLDG. SUITE 100
NEWARK DE
19702-5448
US

V. Phone/Fax

Practice location:
  • Phone: 302-292-0888
  • Fax: 303-292-0889
Mailing address:
  • Phone: 302-292-0888
  • Fax: 303-292-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberC10004287
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC10004287
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: