Healthcare Provider Details

I. General information

NPI: 1528226925
Provider Name (Legal Business Name): MICHAEL ROBERT COHN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 DELANCEY ST
NEW YORK NY
10002-3105
US

IV. Provider business mailing address

90 DELANCEY ST
NEW YORK NY
10002-3105
US

V. Phone/Fax

Practice location:
  • Phone: 212-674-3748
  • Fax:
Mailing address:
  • Phone: 212-674-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ROBERT COHN
Title or Position: OPTOMETRIST SOLE OWNER
Credential:
Phone: 212-674-3748