MEDICARE: DR. IVAN COHEN M.D.

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	2084P0802X	Addiction Psychiatry Physician	C10004287	DE
2	2084P0800X	Psychiatry Physician	C10004287	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588676365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN COHEN M.D.

Provider Business Mailing Address
First Line	:	262 CHAPMAN RD
Second Line	:	BELLEVUE BLDG. SUITE 100
City	:	NEWARK
State	:	DE
Zip	:	19702-5448
Country	:	US
Telephone Number	:	302-292-0888
Fax Number	:	303-292-0889

Provider Business Practice Location Address
First Line	:	262 CHAPMAN RD
Second Line	:	BELLEVUE BLDG. SUITE 100
City	:	NEWARK
State	:	DE
Zip	:	19702-5448
Country	:	US
Telephone Number	:	302-292-0888
Fax Number	:	303-292-0889

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/11/2025

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