Healthcare Provider Details

I. General information

NPI: 1154320471
Provider Name (Legal Business Name): TED COHEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 WESTERN AVE
ALBANY NY
12203-2513
US

IV. Provider business mailing address

940 WESTERN AVE
ALBANY NY
12203-2513
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-6849
  • Fax: 518-438-6840
Mailing address:
  • Phone: 518-438-6849
  • Fax: 518-438-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN002717-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: