Healthcare Provider Details

I. General information

NPI: 1912375791
Provider Name (Legal Business Name): YONATAN COHEN D.M.D., MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL DR
PORT JEFFERSON STATION NY
11776-1601
US

IV. Provider business mailing address

49 FEDERAL LN
CORAM NY
11727-1619
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number058244-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: