MEDICARE: JENNIFER EDYTHE COHEN MD

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	207Q00000X	Family Medicine Physician	53222	CT

General Provider Information

NPI Number	:	1588808521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER EDYTHE COHEN MD

Provider Business Mailing Address
First Line	:	120 MAIN ST FL 4
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-7834
Country	:	US
Telephone Number	:	203-743-0100
Fax Number	:	203-743-3411

Provider Business Practice Location Address
First Line	:	120 MAIN ST FL 4
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-7834
Country	:	US
Telephone Number	:	203-743-0100
Fax Number	:	203-743-3411

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

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/01/2021

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