Provider Demographics
NPI:1083812176
Name:COHEN, MARLENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARLENE
Other - Middle Name:
Other - Last Name:WEHR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:28 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4614
Mailing Address - Country:US
Mailing Address - Phone:516-632-8059
Mailing Address - Fax:
Practice Address - Street 1:28 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4614
Practice Address - Country:US
Practice Address - Phone:516-632-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY475368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02879367MedicaidMEDICADE PROVIDER NUMBER