Provider Demographics
NPI:1174666820
Name:COHEN, MICHELLE STACEY (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:STACEY
Last Name:COHEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9539
Mailing Address - Country:US
Mailing Address - Phone:732-786-9302
Mailing Address - Fax:732-972-8668
Practice Address - Street 1:59 FIVE POINTS RD
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1781
Practice Address - Country:US
Practice Address - Phone:732-761-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001004002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer