Healthcare Provider Details

I. General information

NPI: 1598036816
Provider Name (Legal Business Name): JASON COHEN PA-C, ATC, OTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 PRYTANIA ST SUITE 430
NEW ORLEANS LA
70115-3532
US

IV. Provider business mailing address

3434 PRYTANIA ST SUITE 430
NEW ORLEANS LA
70115-3532
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-6391
  • Fax:
Mailing address:
  • Phone: 504-899-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number302676
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH.200182
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number11-0217
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: