Provider Demographics
NPI:1417071044
Name:COHEN, IRA JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:JAY
Last Name:COHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18011 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1619
Mailing Address - Country:US
Mailing Address - Phone:718-969-1010
Mailing Address - Fax:718-376-0034
Practice Address - Street 1:18011 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1619
Practice Address - Country:US
Practice Address - Phone:718-969-1010
Practice Address - Fax:718-376-0034
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY369411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice