Provider Demographics
NPI:1821031147
Name:COHEN, STEPHANIE MERYL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MERYL
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-487-3400
Mailing Address - Fax:201-487-2481
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-487-3400
Practice Address - Fax:201-487-2481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67408208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74981Medicare UPIN
NJ012100Medicare ID - Type Unspecified