Provider Demographics
NPI:1235294315
Name:JACOB S COHEN & SAMMY GOLDSTEIN DDS PC
Entity Type:Organization
Organization Name:JACOB S COHEN & SAMMY GOLDSTEIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-863-0816
Mailing Address - Street 1:707 SUMMIT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3463
Mailing Address - Country:US
Mailing Address - Phone:201-863-0816
Mailing Address - Fax:201-866-3448
Practice Address - Street 1:707 SUMMIT AVE STE 2
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3463
Practice Address - Country:US
Practice Address - Phone:201-863-0816
Practice Address - Fax:201-866-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ159581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEIN #