Provider Demographics
NPI:1629250428
Name:GASTROENTEROLOGY ASSOCIATES OF THE TREASURE COAST, P.A.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF THE TREASURE COAST, P.A.
Other - Org Name:KENNETH R. KOHEN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:KOHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-335-7883
Mailing Address - Street 1:1700 SE HILLMOOR DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7539
Mailing Address - Country:US
Mailing Address - Phone:772-335-7883
Mailing Address - Fax:772-335-3143
Practice Address - Street 1:1700 SE HILLMOOR DR
Practice Address - Street 2:SUITE 402
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7539
Practice Address - Country:US
Practice Address - Phone:772-335-7883
Practice Address - Fax:772-335-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty