Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 188715 | NY |
NPI | 1104036516 |
---|---|
Provider Name | Adam Cohen |
First Address | Great Neck, NY 11021-5341 |
Second Address | Great Neck, NY 11021-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 13/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01975855 | (05) | NY |
F64448 | (02) | NY |