Provider Demographics
NPI:1689156846
Name:COHEN, EMILY REBECCA (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:REBECCA
Last Name:COHEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 BAMFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3849
Mailing Address - Country:US
Mailing Address - Phone:732-986-7701
Mailing Address - Fax:
Practice Address - Street 1:1139 RARITAN RD STE 200
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1344
Practice Address - Country:US
Practice Address - Phone:732-815-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01808600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist