Provider Demographics
NPI:1790901080
Name:COHEN, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
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 1:160 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3420
Mailing Address - Country:US
Mailing Address - Phone:518-584-0638
Mailing Address - Fax:
Practice Address - Street 1:52 WASHINGTON ST RM 122N
Practice Address - Street 2:OFFICE OF CHILDREN AND FAMILY SERVICES
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-2834
Practice Address - Country:US
Practice Address - Phone:518-474-9560
Practice Address - Fax:518-486-7099
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1622802080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine