Healthcare Provider Details

I. General information

NPI: 1881930683
Provider Name (Legal Business Name): DR. YITZCHAK COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 UNION ST APT 1AB
LODI NJ
07644-3226
US

IV. Provider business mailing address

PO BOX 1054
CLIFTON NJ
07014-1054
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberR84297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: