Healthcare Provider Details

I. General information

NPI: 1710007794
Provider Name (Legal Business Name): SANDRA COHEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3201
  • Fax: 718-343-5864
Mailing address:
  • Phone: 516-876-5555
  • Fax: 516-876-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number010982
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: