Provider Demographics
NPI:1043824246
Name:COHEN, JONATHAN
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:33 W 93RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7604
Mailing Address - Country:US
Mailing Address - Phone:917-885-9053
Mailing Address - Fax:
Practice Address - Street 1:300 CENTRAL PARK W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1513
Practice Address - Country:US
Practice Address - Phone:212-877-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical