Provider Demographics
NPI:1164492948
Name:COHEN, MELISSA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:J
Last Name:COHEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8600
Mailing Address - Country:US
Mailing Address - Phone:315-452-1676
Mailing Address - Fax:315-452-4567
Practice Address - Street 1:7750 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8600
Practice Address - Country:US
Practice Address - Phone:315-452-1676
Practice Address - Fax:315-452-4567
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO3717213EP1101X
NYN003717332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00852433Medicaid
NY4004810001Medicare NSC
NYT26699Medicare UPIN
NY00852433Medicaid