Provider Demographics
NPI:1255475430
Name:COHEN, RICHARD I (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2823
Mailing Address - Country:US
Mailing Address - Phone:201-332-0403
Mailing Address - Fax:201-332-7364
Practice Address - Street 1:178 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2823
Practice Address - Country:US
Practice Address - Phone:201-332-0403
Practice Address - Fax:201-332-7364
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ125241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice