Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 053567 | NY |
Y | 1223P0300X | Periodontist | DN16843 | FL |
NPI | 1073762506 |
---|---|
Provider Name | Jessica Camille Cohen |
First Address | Naples, FL 34102-5702 |
Second Address | Naples, FL 34102-5702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2008 |
Last Update Date | 10/01/2018 |