Healthcare Provider Details

I. General information

NPI: 1831664226
Provider Name (Legal Business Name): COHEN FOOT & ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 UNION ST
LODI NJ
07644-3226
US

IV. Provider business mailing address

384 RUTHERFORD BLVD
CLIFTON NJ
07014-1221
US

V. Phone/Fax

Practice location:
  • Phone: 201-654-6507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: YITZCHAK COHEN
Title or Position: DPM
Credential:
Phone: 201-654-6507