MEDICARE: JAY L 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	207N00000X	Dermatology Physician	079748	MA

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	:	1851371132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY L COHEN MD

Provider Business Mailing Address
First Line	:	464 HILLSIDE AVE
Second Line	:	SUITE 303
City	:	NEEDHAM
State	:	MA
Zip	:	02494-1227
Country	:	US
Telephone Number	:	781-449-3588
Fax Number	:	781-449-5474

Provider Business Practice Location Address
First Line	:	464 HILLSIDE AVE
Second Line	:	SUITE 303
City	:	NEEDHAM
State	:	MA
Zip	:	02494-1227
Country	:	US
Telephone Number	:	781-449-3588
Fax Number	:	781-449-5474

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/23/2011

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