Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 01025325A | IN |
N | 2080P0210X | Pediatric Nephrologist | 01025325A | IN |
NPI | 1215932579 |
---|---|
Provider Name | Dr. Steven J Cohen |
First Address | Fort Wayne, IN 46804-4159 |
Second Address | Fort Wayne, IN 46804-4159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100360920 | (05) | IN |
C24502 | (02) | IN |