Provider Demographics
NPI:1265647671
Name:COHEN, ALFRED PHILLIP (OD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:PHILLIP
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 MADEIRA BLVD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-846-4224
Mailing Address - Fax:
Practice Address - Street 1:2169 MERRICK RD
Practice Address - Street 2:EVERYTHING OPTICAL FOR LESS, INC.
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4720
Practice Address - Country:US
Practice Address - Phone:516-223-1616
Practice Address - Fax:516-223-8590
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0028321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00420219Medicaid
NYA400010240Medicare PIN
NY00420219Medicaid