Healthcare Provider Details

I. General information

NPI: 1184992471
Provider Name (Legal Business Name): WAYNE COHEN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BLVD
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

61 MANORHAVEN BLVD
PORT WASHINGTON NY
11050-1627
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-6000
  • Fax:
Mailing address:
  • Phone: 516-883-7100
  • Fax: 516-883-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number167750
License Number StateNY

VIII. Authorized Official

Name: WAYNE T COHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 516-883-7100