Provider Demographics
NPI:1164515623
Name:COHEN, IRWIN D (DPM)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1719
Mailing Address - Country:US
Mailing Address - Phone:650-726-3338
Mailing Address - Fax:650-560-9492
Practice Address - Street 1:585 KELLY ST
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019
Practice Address - Country:US
Practice Address - Phone:650-726-3338
Practice Address - Fax:650-560-9492
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1610213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11007Medicare UPIN
CA0987350001Medicare NSC
CA000E16100Medicare PIN
CA000E16101Medicare ID - Type UnspecifiedPALO ALTO LOCATION
CA0987350002Medicare NSC