Provider Demographics
NPI:1114085750
Name:COHEN, STANLEY BART (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:BART
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 POST AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3432
Mailing Address - Country:US
Mailing Address - Phone:212-942-8744
Mailing Address - Fax:212-942-8744
Practice Address - Street 1:128 POST AVE
Practice Address - Street 2:SUITE K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3432
Practice Address - Country:US
Practice Address - Phone:212-942-8744
Practice Address - Fax:212-942-8744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00855918Medicaid
0096871OtherGROUP HEALTH INCORPORATED
54160NOtherCIGNA
NP1275OtherOXFORD
C09009Medicare UPIN
35D381Medicare ID - Type Unspecified