Provider Demographics
NPI:1063667350
Name:COHEN, RHODA T
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:T
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3207
Mailing Address - Country:US
Mailing Address - Phone:516-551-7780
Mailing Address - Fax:516-349-8411
Practice Address - Street 1:10 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3207
Practice Address - Country:US
Practice Address - Phone:516-551-7780
Practice Address - Fax:516-349-8411
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0577OtherSPEECH LICENSE NEW YORK STATE 0577