Healthcare Provider Details

I. General information

NPI: 1154585743
Provider Name (Legal Business Name): PETA COHEN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N DEAN ST 2ND FLOOR
ENGLEWOOD NJ
07631-2804
US

IV. Provider business mailing address

11 N DEAN ST 2ND FLOOR
ENGLEWOOD NJ
07631-2804
US

V. Phone/Fax

Practice location:
  • Phone: 201-541-7601
  • Fax: 201-541-7876
Mailing address:
  • Phone: 201-541-7601
  • Fax: 201-541-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number853204
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: