Provider Demographics
NPI:1255313722
Name:COHEN, BRIAN M
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 BIG OAK RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6418
Mailing Address - Country:US
Mailing Address - Phone:215-369-3937
Mailing Address - Fax:
Practice Address - Street 1:1581 BIG OAK RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6418
Practice Address - Country:US
Practice Address - Phone:215-369-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000508152W00000X
NJTO01042152WV0400X
NJ27OA00559800156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
939849OtherONE HEALTHPLAN
0219710000OtherAMERIHEALTH
38150OtherMASTERCARE
0219710000OtherKEYSTONE
1157248OtherHORIZON NJ HEALTH
2169304OtherUNITED HEALTHCARE
2565171OtherAETNA
1K8868OtherHEALTHNET
NJ8522201Medicaid
NJ5598OtherEYEMED
1914518OtherFIRST HEALTH
P2598583OtherOXFORD
1157248OtherHORIZON NJ HEALTH
2565171OtherAETNA
NJ8522201Medicaid
NJ048049CJPMedicare PIN