Provider Demographics
NPI:1760462436
Name:COHEN, PAUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 KINGS WALK
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3906
Mailing Address - Country:US
Mailing Address - Phone:516-795-6327
Mailing Address - Fax:516-799-3597
Practice Address - Street 1:1310 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4238
Practice Address - Country:US
Practice Address - Phone:718-221-0415
Practice Address - Fax:516-799-3597
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179062173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01586649Medicaid
73F822Medicare ID - Type Unspecified
WLG561Medicare ID - Type Unspecified
NY01586649Medicaid
73F821Medicare ID - Type Unspecified