Provider Demographics
NPI:1275679763
Name:COHEN, FREDERIC E (DMD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:E
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 1:607 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3115
Mailing Address - Country:US
Mailing Address - Phone:516-312-0729
Mailing Address - Fax:
Practice Address - Street 1:2814 CLARENDON RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6318
Practice Address - Country:US
Practice Address - Phone:718-469-0014
Practice Address - Fax:718-469-7551
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05-0085-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02319015Medicaid