Provider Demographics
NPI:1003358110
Name:JOSHUA R COHEN PHD
Entity Type:Organization
Organization Name:JOSHUA R COHEN PHD
Other - Org Name:JOSHUA R COHEN PHD LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA R COHEN
Authorized Official - Middle Name:PHD
Authorized Official - Last Name:LLC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-530-9330
Mailing Address - Street 1:1000 SANGER AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1241
Mailing Address - Country:US
Mailing Address - Phone:732-200-2570
Mailing Address - Fax:732-455-9596
Practice Address - Street 1:1000 SANGER AVE STE 17
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1241
Practice Address - Country:US
Practice Address - Phone:732-200-2570
Practice Address - Fax:732-455-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35SI00449000OtherNJ LICENSE