Provider Demographics
NPI:1275549305
Name:COHEN, DOUGLAS S (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
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:PO BOX 95000-2234
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2234
Mailing Address - Country:US
Mailing Address - Phone:212-523-8500
Mailing Address - Fax:212-523-8505
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:DEPARTMENT OF NEUROSURGERY SUITE 5G-80
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2023171207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01654920Medicaid
G37766Medicare UPIN
NY01654920Medicaid