MEDICARE: JEFFREY DAVID COHEN P.A.-C

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	363AM0700X	Medical Physician Assistant	PA 3582	FL
2	363A00000X	Physician Assistant	005275-1	NY
3	363AM0700X	Medical Physician Assistant	PA07448	TX

General Provider Information

NPI Number	:	1972563658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DAVID COHEN P.A.-C

Provider Business Mailing Address
First Line	:	55 CAMBRIDGE LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-6216
Country	:	US
Telephone Number	:	305-458-4788
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 CAMBRIDGE LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-6216
Country	:	US
Telephone Number	:	305-458-4788
Fax Number	:

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	03/22/2015

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