Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 25MA08142300 | NJ |
NPI | 1073515524 |
---|---|
Provider Name | Dr. Ian Thomas Cohen |
First Address | Buffalo, NY 14267-0002 |
Second Address | Long Branch, NJ 07740-6303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 14/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0123030 | (05) | NJ |