Provider Demographics
NPI:1336286731
Name:COHEN, LAWRENCE MARC (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MARC
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 E SUNRISE HWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1329
Mailing Address - Country:US
Mailing Address - Phone:516-561-2102
Mailing Address - Fax:516-568-9485
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:516-561-2102
Practice Address - Fax:516-568-9485
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN2839213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00403838Medicaid
NY00403838Medicaid
NYT50892Medicare UPIN