Provider Demographics
NPI:1790716447
Name:HERBERT S RADLEY MD & HAROLD M COHEN MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HERBERT S RADLEY MD & HAROLD M COHEN MD MEDICAL CORPORATION
Other - Org Name:SYLMAR MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:FANOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-367-1012
Mailing Address - Street 1:14124 FOOTHILL BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-8049
Mailing Address - Country:US
Mailing Address - Phone:818-367-1012
Mailing Address - Fax:818-367-7570
Practice Address - Street 1:14124 FOOTHILL BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-8049
Practice Address - Country:US
Practice Address - Phone:818-367-1012
Practice Address - Fax:818-367-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ70244ZMedicaid
CAI48477Medicare UPIN
CAI51207Medicare UPIN
CAA27783Medicare UPIN
CAW5510Medicare ID - Type UnspecifiedRADLEY AND COHEN
CAZZZ70244ZMedicaid