Healthcare Provider Details

I. General information

NPI: 1972647246
Provider Name (Legal Business Name): JACK COHEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 ARTHUR GODFREY RD STE 204
MIAMI BEACH FL
33140-3520
US

IV. Provider business mailing address

524 ARTHUR GODFREY RD STE 204
MIAMI BEACH FL
33140-3520
US

V. Phone/Fax

Practice location:
  • Phone: 786-276-3668
  • Fax: 305-535-1004
Mailing address:
  • Phone: 786-276-3668
  • Fax: 305-535-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: