MEDICARE: JACOB S COHEN & SAMMY GOLDSTEIN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15958	NJ

General Provider Information

NPI Number	:	1235294315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB S COHEN & SAMMY GOLDSTEIN DDS PC

Provider Business Mailing Address
First Line	:	707 SUMMIT AVE STE 2
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3463
Country	:	US
Telephone Number	:	201-863-0816
Fax Number	:	201-866-3448

Provider Business Practice Location Address
First Line	:	707 SUMMIT AVE STE 2
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3463
Country	:	US
Telephone Number	:	201-863-0816
Fax Number	:	201-866-3448

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB S COHEN
Credential	:	DDS
Telephone Number	:	201-863-0816

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	06/21/2018

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