Provider Demographics
NPI:1760594485
Name:COHN, IRIS
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:COHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 70 KISSENA BLVD
Mailing Address - Street 2:SUITE LH
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-353-8787
Mailing Address - Fax:718-353-1367
Practice Address - Street 1:43 70 KISSENA BLVD
Practice Address - Street 2:SUITE LH
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-353-8787
Practice Address - Fax:718-353-1367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003226213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00804348Medicaid
NY00804348Medicaid
NY26626Medicare PIN