Healthcare Provider Details

I. General information

NPI: 1639254485
Provider Name (Legal Business Name): LAURIE E COHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/13/2023
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

3411 WAYNE AVE FL 4M
BRONX NY
10467-2535
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4664
  • Fax: 617-730-0194
Mailing address:
  • Phone: 718-920-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number73889
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: