MEDICARE: ELIE NATAN COHEN PHD

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	103TC0700X	Clinical Psychologist	020858	NY

General Provider Information

NPI Number	:	1457751059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIE NATAN COHEN PHD

Provider Business Mailing Address
First Line	:	1226 W BROADWAY STE 5
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1923
Country	:	US
Telephone Number	:	516-558-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 W BROADWAY STE 5
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1923
Country	:	US
Telephone Number	:	516-558-3010
Fax Number	:

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	08/23/2019

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