Provider Demographics
NPI:1104036516
Name:COHEN, ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:STE 340
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5341
Mailing Address - Country:US
Mailing Address - Phone:516-482-9090
Mailing Address - Fax:516-775-3080
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:STE 340
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5341
Practice Address - Country:US
Practice Address - Phone:516-775-9090
Practice Address - Fax:516-775-3080
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188715207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01975855Medicaid
NYF64448Medicare UPIN
NY01975855Medicaid