Provider Demographics
NPI:1073505103
Name:COHEN, LORI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-439-5223
Mailing Address - Fax:516-439-5227
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-439-5223
Practice Address - Fax:516-439-5227
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96243Medicare UPIN
59N721Medicare ID - Type Unspecified