Provider Demographics
NPI:1790962603
Name:COHEN, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:COHEN
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 1:60 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1805
Mailing Address - Country:US
Mailing Address - Phone:201-689-0684
Mailing Address - Fax:201-689-5084
Practice Address - Street 1:60 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1805
Practice Address - Country:US
Practice Address - Phone:201-689-0684
Practice Address - Fax:201-689-5084
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044077-1183500000X
NJ28RIO3356300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist