Provider Demographics
NPI:1760827166
Name:COHEN DERMATOPATHOLOGY, PC
Entity Type:Organization
Organization Name:COHEN DERMATOPATHOLOGY, PC
Other - Org Name:INFORM DIAGNOSTICS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-309-2674
Mailing Address - Street 1:6655 NORTH MACARTHUR BOULEVARD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPARTMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2443
Mailing Address - Country:US
Mailing Address - Phone:214-596-7031
Mailing Address - Fax:
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:SUITE 332
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1934
Practice Address - Country:US
Practice Address - Phone:617-969-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD300225408Medicare PIN