Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25MA06221000 | NJ |
NPI | 1053301085 |
---|---|
Provider Name | Benjamin Cohen |
First Address | Newark, NJ 07191-8751 |
Second Address | Long Branch, NJ 07740-6205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 11/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0547722 | AETNA (01) | NJ |
0796887000 | AMERIHEALTH (01) | NJ |
5715271 | GHI (01) | NJ |
92F391 | BC/BS (01) | NJ |
F20132 | (02) | NJ |
J20028 | PHS NON-PAR (01) | NJ |