Healthcare Provider Details

I. General information

NPI: 1497795843
Provider Name (Legal Business Name): DR. LEE S COHEN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 EAST CHESTER PIKE
RIDLEY PARK PA
19078
US

IV. Provider business mailing address

642 EAST CHESTER PIKE
RIDLEY PARK PA
19078
US

V. Phone/Fax

Practice location:
  • Phone: 610-522-9200
  • Fax: 610-522-9478
Mailing address:
  • Phone: 610-522-9200
  • Fax: 610-522-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberSC001567L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001567L
License Number StatePA

VIII. Authorized Official

Name: LEE S COHEN
Title or Position: OWNER / PRESIDENT
Credential: D.P.M.
Phone: 610-522-9200