Healthcare Provider Details

I. General information

NPI: 1023245339
Provider Name (Legal Business Name): ISRAEL COHEN L.C.S.W.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N BROADWAY
NYACK NY
10960-1212
US

IV. Provider business mailing address

406 N BROADWAY
NYACK NY
10960-1212
US

V. Phone/Fax

Practice location:
  • Phone: 845-358-2239
  • Fax:
Mailing address:
  • Phone: 845-358-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR000150
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNO5981
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE PTAN (PERTAINS TO ISRAEL COHEN LCSW AAND MAY NOT APPLY)

VIII. Authorized Official

Name: MR. ISRAEL COHEN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 845-358-2239