Provider Demographics
NPI:1285681569
Name:COHEN, MICHAEL S (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
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 1:225 N ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9751
Mailing Address - Country:US
Mailing Address - Phone:856-767-9101
Mailing Address - Fax:856-767-9131
Practice Address - Street 1:225 N ROUTE 73
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9751
Practice Address - Country:US
Practice Address - Phone:856-767-9101
Practice Address - Fax:856-767-9131
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00346000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1739204Medicaid