MEDICARE: DR. MORTON J COHEN DDS

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	122300000X	Dentist	DS016660L	PA

General Provider Information

NPI Number	:	1366550857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORTON J COHEN DDS

Provider Business Mailing Address
First Line	:	1102 WOODED WAY DR
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-2241
Country	:	US
Telephone Number	:	610-566-5137
Fax Number	:

Provider Business Practice Location Address
First Line	:	2759 ISLAND RD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19153-2225
Country	:	US
Telephone Number	:	215-727-1043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	07/08/2007

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