Healthcare Provider Details

I. General information

NPI: 1598906836
Provider Name (Legal Business Name): JEROME COHEN DDS, ROBERT STORCH DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 GARDINERS AVE
LEVITTOWN NY
11756
US

IV. Provider business mailing address

61 GARDINERS AVE
LEVITTOWN NY
11756
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-4300
  • Fax:
Mailing address:
  • Phone: 516-731-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number027436-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number030384-1
License Number StateNY

VIII. Authorized Official

Name: DR. JEROME COHEN
Title or Position: PRES OWNER
Credential: DDS
Phone: 516-731-4300