Provider Demographics
NPI:1659301166
Name:COHEN, STEPHEN C (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FULD ST
Mailing Address - Street 2:STE 401
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-5247
Mailing Address - Country:US
Mailing Address - Phone:609-599-1004
Mailing Address - Fax:609-599-3611
Practice Address - Street 1:40 FULD ST
Practice Address - Street 2:STE 401
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-5247
Practice Address - Country:US
Practice Address - Phone:609-599-1004
Practice Address - Fax:609-599-3611
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD66248207RN0300X
NJMD066248207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9038001Medicaid
H55426Medicare UPIN
NJ9038001Medicaid