Provider Demographics
NPI:1164805271
Name:COHEN, MARISSA SHANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:SHANNON
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1113 YORK AVE APT 22C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8794
Mailing Address - Country:US
Mailing Address - Phone:516-382-3297
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-0780
Practice Address - Fax:212-746-4883
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT209751207P00000X
PAMD462711207P00000X
NY305283-01207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine