Provider Demographics
NPI:1417475880
Name:COHN, IAN (DPT, PT, ATC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:COHN
Suffix:
Gender:M
Credentials:DPT, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416495
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4142
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:210 NORTH AVE E STE 1
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2491
Practice Address - Country:US
Practice Address - Phone:908-276-0237
Practice Address - Fax:908-276-5692
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041967225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist