Provider Demographics
NPI:1053301085
Name:COHEN, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18751
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8751
Mailing Address - Country:US
Mailing Address - Phone:732-222-8323
Mailing Address - Fax:732-870-9488
Practice Address - Street 1:279 THIRD AVENUE
Practice Address - Street 2:SUITE 603
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6205
Practice Address - Country:US
Practice Address - Phone:732-222-8323
Practice Address - Fax:732-870-9488
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06221000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0796887000OtherAMERIHEALTH
NJ5715271OtherGHI
NJJ20028OtherPHS NON-PAR
NJ92F391OtherBC/BS
NJ0547722OtherAETNA
NJF20132Medicare UPIN
NJ722264QZKMedicare PIN
NJ070007945Medicare PIN