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General NPI Number Information
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NPI Number | 1053301085
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Entity Type | Individual
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Provider Name | BENJAMIN COHEN
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 279 THIRD AVENUE SUITE 603
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City | LONG BRANCH
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State | NJ
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Zip | 07740-6205
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Country | US
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Telephone | 732-222-8323
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Fax | 732-870-9488
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Provider Business Mailing Address
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Address Line | PO BOX 18751
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City | NEWARK
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State | NJ
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Zip | 07191-8751
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Country | US
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Telephone | 732-222-8323
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Fax | 732-870-9488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA06221000
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License Number State | NJ
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