Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS025624L | PA |
NPI | 1164400347 |
---|---|
Provider Name | Dr. Jay Spencer Cohen |
First Address | Allentown, PA 18103-6206 |
Second Address | Allentown, PA 18103-6206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 27/07/2007 |