Healthcare Provider Details

I. General information

NPI: 1275531857
Provider Name (Legal Business Name): MICHAEL COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 MERRICK RD
OCEANSIDE NY
11572-1427
US

IV. Provider business mailing address

258 MERRICK RD
OCEANSIDE NY
11572-1427
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-0345
  • Fax: 516-255-5353
Mailing address:
  • Phone: 516-766-0345
  • Fax: 516-255-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number173403-5
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: