Provider Demographics
NPI:1710115746
Name:COWEN, VIRGINIA S (PHD, MT)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:S
Last Name:COWEN
Suffix:
Gender:F
Credentials:PHD, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BOWERS LN
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1505
Mailing Address - Country:US
Mailing Address - Phone:210-414-8093
Mailing Address - Fax:
Practice Address - Street 1:145 PIERMONT ROAD
Practice Address - Street 2:JUMPING FROG STUDIOS
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-414-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist