Provider Demographics
NPI:1497758965
Name:COHEN, LESTER (CRNP)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WISSAHICKON AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:267-597-3600
Mailing Address - Fax:267-597-3622
Practice Address - Street 1:6120-B WOODLAND AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:215-727-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001023B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011451120005Medicaid