Provider Demographics
NPI:1033662002
Name:MARC COHEN
Entity Type:Organization
Organization Name:MARC COHEN
Other - Org Name:MARLBORO PODIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-780-8787
Mailing Address - Street 1:223 TAYLOR MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3229
Mailing Address - Country:US
Mailing Address - Phone:732-780-8787
Mailing Address - Fax:732-577-1106
Practice Address - Street 1:223 TAYLORS MILLS RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3229
Practice Address - Country:US
Practice Address - Phone:732-780-8787
Practice Address - Fax:732-577-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00135100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1083602593OtherMEDICARE SOLE PRACTICTIONER IND ID TYPE I
NJT44901Medicare UPIN