Provider Demographics
NPI:1063488146
Name:COHEN, RANDI L (APRN, BC)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:L
Last Name:COHEN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1209
Mailing Address - Country:US
Mailing Address - Phone:973-660-0555
Mailing Address - Fax:973-660-0556
Practice Address - Street 1:256 COLUMBIA TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1209
Practice Address - Country:US
Practice Address - Phone:973-660-0555
Practice Address - Fax:973-660-0556
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07906000364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP49044Medicare UPIN