=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467568154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEROLD A. COHEN, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5800 COLONIAL DR SUITE 207
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063-5682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-979-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5800 COLONIAL DR SUITE 207
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063-5682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEROLD ARNOLD COHEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-979-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME36181
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------