Healthcare Provider Details

I. General information

NPI: 1457675571
Provider Name (Legal Business Name): MR. JAMES COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVENUE
BRONX NY
10457
US

IV. Provider business mailing address

14 ORCHARD RD
DEMAREST NY
07627-1614
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6179
  • Fax:
Mailing address:
  • Phone: 201-660-7856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: