Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 09564 | NJ |
NPI | 1023217122 |
---|---|
Provider Name | Dr. Philip Simon Cohen |
First Address | Summit, NJ 07901-2574 |
Second Address | Summit, NJ 07901-2574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 17/07/2007 |