Healthcare Provider Details

I. General information

NPI: 1801847959
Provider Name (Legal Business Name): RANDY E COHEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 RICHMOND AVE
STATEN ISLAND NY
10314-1519
US

IV. Provider business mailing address

1530 RICHMOND AVE
STATEN ISLAND NY
10314-1519
US

V. Phone/Fax

Practice location:
  • Phone: 718-494-7012
  • Fax: 718-698-9894
Mailing address:
  • Phone: 718-494-7012
  • Fax: 718-698-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN002790-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: