Provider Demographics
NPI:1114980356
Name:COHEN, NEIL M (DO)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
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Other - Last Name:
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:2ND FLOOR TPI-CBO
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-926-9000
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:12000 BUSTLETON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2151
Practice Address - Country:US
Practice Address - Phone:215-673-7600
Practice Address - Fax:215-673-1894
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS003689L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006962920001Medicaid
PA0006962920001Medicaid
PAD98630Medicare UPIN