Healthcare Provider Details

I. General information

NPI: 1063590537
Provider Name (Legal Business Name): JASON BRETT COHEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 E TREMONT AVE
BRONX NY
10460-4305
US

IV. Provider business mailing address

949 E TREMONT AVE
BRONX NY
10460-4305
US

V. Phone/Fax

Practice location:
  • Phone: 718-617-3668
  • Fax: 718-617-3824
Mailing address:
  • Phone: 718-617-3668
  • Fax: 718-617-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number005736
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number005736
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number005736
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: