Provider Demographics
NPI:1558334961
Name:COHEN, BRADLEY J (DO)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 7TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5766
Mailing Address - Country:US
Mailing Address - Phone:516-833-3100
Mailing Address - Fax:516-430-5273
Practice Address - Street 1:229 7TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5766
Practice Address - Country:US
Practice Address - Phone:516-833-3100
Practice Address - Fax:516-430-5273
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2050632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07X631Medicare ID - Type Unspecified
G48200Medicare UPIN