Provider Demographics
NPI:1598204927
Name:COHEN, AIDA TEHILLA (MA)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:TEHILLA
Last Name:COHEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 MANETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3428
Mailing Address - Country:US
Mailing Address - Phone:732-948-0030
Mailing Address - Fax:
Practice Address - Street 1:1074 TIMES SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5524
Practice Address - Country:US
Practice Address - Phone:732-948-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00885800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist