Provider Demographics
NPI:1619994183
Name:COHEN, ROBERTA G (MS RN CS)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:G
Last Name:COHEN
Suffix:
Gender:F
Credentials:MS RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 GANNET COURT
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-484-1906
Mailing Address - Fax:516-484-1906
Practice Address - Street 1:2415 JERUSALEM AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-678-8302
Practice Address - Fax:516-484-1906
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140135364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
120759OtherVYTRA
132464OtherEMPIRE VALUE OPTION
7494086OtherEMPIRE GHI PIN
140135OtherHIP
P83534780OtherMULTIPLAN
7121055OtherAETNA
P1075751OtherOXFORD
7494086OtherEMPIRE GHI PIN
R00111Medicare ID - Type Unspecified