Healthcare Provider Details

I. General information

NPI: 1184365488
Provider Name (Legal Business Name): MARC COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 77TH ST FL 6
NEW YORK NY
10075-1851
US

IV. Provider business mailing address

130 E 77TH ST FL 6
NEW YORK NY
10075-1851
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-4763
  • Fax:
Mailing address:
  • Phone: 212-434-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number343881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: