Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 173403-5 | NY |
NPI | 1275531857 |
---|---|
Provider Name | Dr. Michael Cohen |
First Address | Oceanside, NY 11572-1427 |
Second Address | Oceanside, NY 11572-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 07/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E89837 | (02) | NY |