Healthcare Provider Details

I. General information

NPI: 1710993829
Provider Name (Legal Business Name): SUZANNE E COHEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6282 ROUTE 25A
WADING RIVER NY
11792
US

IV. Provider business mailing address

PO BOX 630
WADING RIVER NY
11792-0630
US

V. Phone/Fax

Practice location:
  • Phone: 631-929-6800
  • Fax:
Mailing address:
  • Phone: 631-929-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number047276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: