Provider Demographics
NPI:1497732192
Name:COHEN, TANIA D (PA-C)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:D
Last Name:COHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BUSHWICK RD
Mailing Address - Street 2:STE D
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3839
Mailing Address - Country:US
Mailing Address - Phone:845-454-0088
Mailing Address - Fax:845-454-7099
Practice Address - Street 1:29 FOX ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4714
Practice Address - Country:US
Practice Address - Phone:845-454-0088
Practice Address - Fax:845-454-7099
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009115-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP89558Medicare UPIN