Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 174127 | NY |
Y | 208600000X | Surgeon | 174127 | NY |
N | 2086X0206X | Surgical Oncologist | 174127 | NY |
NPI | 1104859925 |
---|---|
Provider Name | Dr. Bradley David Cohen |
First Address | Bay Shore, NY 11706-7381 |
Second Address | Bay Shore, NY 11706-7381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01151486 | (05) | NY |
174127 | LICENSE (01) | NY |
E28819 | (02) |