Provider Demographics
NPI:1053331645
Name:MISSRI, JOSE COHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:COHEN
Last Name:MISSRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:215-707-5800
Mailing Address - Fax:215-707-3946
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-5800
Practice Address - Fax:215-707-3946
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022487207RC0000X
PAMD431259207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001517Medicare ID - Type UnspecifiedMEDICARE NUMBER
CTH28904Medicare UPIN