Provider Demographics
NPI:1073745030
Name:COHEN, MIA GINTOFT (MD)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:GINTOFT
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:MARIE
Other - Last Name:GINTOFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:450 MAMARONECK AVE STE 415
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-2436
Mailing Address - Country:US
Mailing Address - Phone:914-407-3047
Mailing Address - Fax:914-499-3900
Practice Address - Street 1:450 MAMARONECK AVE STE 415
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2436
Practice Address - Country:US
Practice Address - Phone:914-407-3047
Practice Address - Fax:914-499-3900
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2544022084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry