Provider Demographics
NPI:1588642235
Name:COHEN, LUCY S (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:S
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4399 N NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5813
Mailing Address - Country:US
Mailing Address - Phone:954-746-1503
Mailing Address - Fax:954-746-1562
Practice Address - Street 1:4399 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5813
Practice Address - Country:US
Practice Address - Phone:954-746-1503
Practice Address - Fax:954-746-1562
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042024700Medicaid
FL042024700Medicaid
FL04194Medicare PIN