Provider Demographics
NPI:1477563658
Name:COHEN, SHAHAB (DDS)
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
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 1:372 AVE U
Mailing Address - Street 2:SUITE L1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-372-3151
Mailing Address - Fax:347-492-5899
Practice Address - Street 1:372 AVE U
Practice Address - Street 2:SUITE L1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-372-3151
Practice Address - Fax:347-492-5899
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052100OtherNYS LICENSE #