Provider Demographics
NPI:1245230200
Name:COHEN, JEFFREY LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEWIS
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 425
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-548-7336
Mailing Address - Fax:860-524-2651
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 425
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-548-7336
Practice Address - Fax:860-524-2651
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029057208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0S2102OtherHEALTH NET
MA3163571Medicaid
CT11392OtherHEALTH NEW ENGLAND
CT0396403 001OtherCIGNA
CT981329OtherAETNA
CT029057OtherCONNECTICARE
CT010029057CT01OtherANTHEM BC/BS
CTP901886OtherOXFORD
MA3163571Medicaid