Healthcare Provider Details

I. General information

NPI: 1053633735
Provider Name (Legal Business Name): DR JRCOHEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N 4TH AVE
HIGHLAND PARK NJ
08904-2736
US

IV. Provider business mailing address

164 DARTMOUTH ST
HIGHLAND PARK NJ
08904-3723
US

V. Phone/Fax

Practice location:
  • Phone: 732-648-5238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number35S1004490000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number35S1004490000
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSHUA REUBEN COHEN
Title or Position: OWNER
Credential: PH.D.
Phone: 732-648-5238