Provider Demographics
NPI:1801847959
Name:COHEN, RANDY E (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:E
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1519
Mailing Address - Country:US
Mailing Address - Phone:718-494-7012
Mailing Address - Fax:718-698-9894
Practice Address - Street 1:1530 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1519
Practice Address - Country:US
Practice Address - Phone:718-494-7012
Practice Address - Fax:718-698-9894
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002790-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5696060001Medicare NSC