Provider Demographics
NPI:1639143811
Name:COHEN, JAY MARTIN (OD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MARTIN
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 DORIAN CT
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5206
Mailing Address - Country:US
Mailing Address - Phone:212-938-5863
Mailing Address - Fax:212-938-4135
Practice Address - Street 1:33 WEST 42ND STREET
Practice Address - Street 2:UNIVERSITY OPTOMETRIC CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8005
Practice Address - Country:US
Practice Address - Phone:212-938-4001
Practice Address - Fax:212-938-4135
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003628-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T49132Medicare UPIN
C33691Medicare ID - Type Unspecified