Healthcare Provider Details

I. General information

NPI: 1609870492
Provider Name (Legal Business Name): DANIEL M COHEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAN M COHEN PHD

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 KAPPOCK ST 2H
BRONX NY
10463-6404
US

IV. Provider business mailing address

512 KAPPOCK ST 2H
BRONX NY
10463-6404
US

V. Phone/Fax

Practice location:
  • Phone: 917-796-0498
  • Fax:
Mailing address:
  • Phone: 917-796-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number013987
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2900
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: