Provider Demographics
NPI:1124029590
Name:COHEN, BETH J (DC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:J
Last Name:COHEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 VETERANS HWY
Mailing Address - Street 2:STE 210
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2329
Mailing Address - Country:US
Mailing Address - Phone:631-360-7999
Mailing Address - Fax:631-360-7843
Practice Address - Street 1:740 VETERANS HWY
Practice Address - Street 2:STE 210
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2329
Practice Address - Country:US
Practice Address - Phone:631-360-7999
Practice Address - Fax:631-360-7843
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO6888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-2866933OtherTAX ID#
20-2866933OtherTAX ID#