Provider Demographics
NPI:1316029796
Name:COHEN, PENELOPE J (MD)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:J
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 ROUTE 27
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-220-1222
Mailing Address - Fax:732-220-2944
Practice Address - Street 1:1527 ROUTE 27
Practice Address - Street 2:SUITE 2800
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-220-1222
Practice Address - Fax:732-220-2944
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05523100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE78057Medicare UPIN
NJ636620Medicare ID - Type Unspecified