Provider Demographics
NPI:1679516710
Name:COHEN, LEE S (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 E CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1701
Mailing Address - Country:US
Mailing Address - Phone:610-522-9200
Mailing Address - Fax:610-522-9478
Practice Address - Street 1:642 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1701
Practice Address - Country:US
Practice Address - Phone:610-522-9200
Practice Address - Fax:610-522-9478
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001567L213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0895380001Medicare NSC
PAT72838Medicare UPIN
PA172425Medicare PIN