Provider Demographics
NPI:1659309250
Name:STANLEY Z. COWEN, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STANLEY Z. COWEN, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:COWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-882-7730
Mailing Address - Street 1:PO BOX 4478
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91313-4478
Mailing Address - Country:US
Mailing Address - Phone:818-709-8161
Mailing Address - Fax:818-709-8160
Practice Address - Street 1:43845 10TH ST W
Practice Address - Street 2:#2A
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4800
Practice Address - Country:US
Practice Address - Phone:818-709-8161
Practice Address - Fax:818-709-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17178208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ51689ZOtherBLUE SHIELD GROUP ID
CA00G171780Medicaid
00G171780OtherBLUE SHIELD INDIVIDUAL ID
G17178OtherPRIVATE INSURANCE ID
ZZZ51689ZOtherBLUE SHIELD GROUP ID
=========OtherEIN & TIN #
CA00G171780Medicaid