Provider Demographics
NPI:1114275112
Name:COHN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:COHN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:AMICA
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-964-0458
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4460
Mailing Address - Country:US
Mailing Address - Phone:510-964-0458
Mailing Address - Fax:510-964-0476
Practice Address - Street 1:2001 DWIGHT WAY RM 2350
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-4738
Practice Address - Fax:510-204-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110257208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty