Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N002717-1 | NY |
NPI | 1154320471 |
---|---|
Provider Name | Dr. Ted Cohen |
First Address | Albany, NY 12203-2513 |
Second Address | Albany, NY 12203-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T26394 | (02) | NY |