Healthcare Provider Details

I. General information

NPI: 1760462436
Provider Name (Legal Business Name): PAUL H COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 PRESIDENT ST
BROOKLYN NY
11213-4238
US

IV. Provider business mailing address

72 KINGS WALK
MASSAPEQUA PARK NY
11762-3906
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-0415
  • Fax: 516-799-3597
Mailing address:
  • Phone: 516-795-6327
  • Fax: 516-799-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number179062
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: