Provider Demographics
NPI:1396178265
Name:COHEN, MARK E (LMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:COHEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ST LAWRENCE WAY
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1272
Mailing Address - Country:US
Mailing Address - Phone:732-539-0175
Mailing Address - Fax:
Practice Address - Street 1:56 ST LAWRENCE WAY
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1272
Practice Address - Country:US
Practice Address - Phone:732-539-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18T00069800171W00000X
NJ18KT00069800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171W00000XOther Service ProvidersContractor