Provider Demographics
NPI:1417972928
Name:COHEN, JEFFREY IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:IRA
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PONDFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-337-5956
Mailing Address - Fax:914-337-6055
Practice Address - Street 1:1 PONDFIELD RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3706
Practice Address - Country:US
Practice Address - Phone:914-337-5956
Practice Address - Fax:914-337-6055
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11123Medicare UPIN
NY54A661Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #