Healthcare Provider Details

I. General information

NPI: 1619041498
Provider Name (Legal Business Name): WAYNE T COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 GREAT NECK RD STE 300
GREAT NECK NY
11021-4308
US

IV. Provider business mailing address

26 HARBOR PARK DR
PORT WASHINGTON NY
11050-4602
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-6747
  • Fax:
Mailing address:
  • Phone: 516-883-7100
  • Fax: 516-883-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number167750
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: