Healthcare Provider Details

I. General information

NPI: 1003358110
Provider Name (Legal Business Name): JOSHUA R COHEN PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SANGER AVE STE 17
OCEANPORT NJ
07757-1241
US

IV. Provider business mailing address

1000 SANGER AVE STE 17
OCEANPORT NJ
07757-1241
US

V. Phone/Fax

Practice location:
  • Phone: 732-200-2570
  • Fax: 732-455-9596
Mailing address:
  • Phone: 732-200-2570
  • Fax: 732-455-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA R COHEN PHD LLC
Title or Position: MANAGING MEMBER
Credential: PH.D.
Phone: 732-530-9330