Provider Demographics
NPI:1073736609
Name:DR. JAMES R. COWAN, JR. M.D. P.A.
Entity Type:Organization
Organization Name:DR. JAMES R. COWAN, JR. M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:LARUE
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:I
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:201-670-4124
Mailing Address - Street 1:61 N MAPLE AVE
Mailing Address - Street 2:SUITE # 305
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3255
Mailing Address - Country:US
Mailing Address - Phone:201-670-4124
Mailing Address - Fax:201-670-4120
Practice Address - Street 1:61 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3255
Practice Address - Country:US
Practice Address - Phone:201-670-4124
Practice Address - Fax:201-670-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ147846Medicare PIN