Healthcare Provider Details

I. General information

NPI: 1396667069
Provider Name (Legal Business Name): MELISSA DORIS COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COURT ST STE 1217
BROOKLYN NY
11201-4410
US

IV. Provider business mailing address

95 ROSE DR
RONKONKOMA NY
11779-3143
US

V. Phone/Fax

Practice location:
  • Phone: 347-474-4484
  • Fax:
Mailing address:
  • Phone: 631-830-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1870711251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: