Provider Demographics
NPI:1417095878
Name:COHEN, ALLAN N (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:N
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 1:1609 215TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1226
Mailing Address - Country:US
Mailing Address - Phone:212-260-2700
Mailing Address - Fax:212-780-9271
Practice Address - Street 1:126 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4555
Practice Address - Country:US
Practice Address - Phone:212-260-2700
Practice Address - Fax:212-780-9271
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY87484Medicare UPIN