Healthcare Provider Details

I. General information

NPI: 1356139992
Provider Name (Legal Business Name): ITAY COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ITAY COHEN MD

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 866-962-7337
  • Fax:
Mailing address:
  • Phone: 844-832-1956
  • Fax: 989-633-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: