Healthcare Provider Details

I. General information

NPI: 1679704779
Provider Name (Legal Business Name): JASON R. COHEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 VILLAGE BLVD SUITE #150
WEST PALM BEACH FL
33409-1945
US

IV. Provider business mailing address

560 VILLAGE BLVD SUITE #150
WEST PALM BEACH FL
33409-1945
US

V. Phone/Fax

Practice location:
  • Phone: 561-331-8800
  • Fax: 561-331-8074
Mailing address:
  • Phone: 561-331-8800
  • Fax: 561-331-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS12212
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code193200000X
TaxonomyMulti-Specialty Group
License NumberOS12212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: