Healthcare Provider Details

I. General information

NPI: 1891348298
Provider Name (Legal Business Name): DANIEL COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 EVERETT AVE
CHELSEA MA
02150-1807
US

IV. Provider business mailing address

1285 BEACON ST
BROOKLINE MA
02446-5237
US

V. Phone/Fax

Practice location:
  • Phone: 617-884-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: