Healthcare Provider Details

I. General information

NPI: 1437730678
Provider Name (Legal Business Name): VANESSA COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 61ST ST STE 6D
NEW YORK NY
10065-8185
US

IV. Provider business mailing address

115 E 61ST ST STE 6D
NEW YORK NY
10065-8185
US

V. Phone/Fax

Practice location:
  • Phone: 212-583-7605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number063053-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: