Healthcare Provider Details

I. General information

NPI: 1275535734
Provider Name (Legal Business Name): STEPHEN MARK COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE SUITE 530
SYRACUSE NY
13210-1651
US

IV. Provider business mailing address

739 IRVING AVE SUITE 530
SYRACUSE NY
13210-1651
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-1158
  • Fax: 315-478-3014
Mailing address:
  • Phone: 315-478-1158
  • Fax: 315-478-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number209563-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: