Provider Demographics
NPI:1841385283
Name:COHEN, IRA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:J
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 1:1184 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4629
Mailing Address - Country:US
Mailing Address - Phone:718-290-7958
Mailing Address - Fax:718-252-1487
Practice Address - Street 1:1184 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4629
Practice Address - Country:US
Practice Address - Phone:718-290-7958
Practice Address - Fax:718-252-1487
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0084707OtherGHI
NY00728189Medicaid
NY0084707OtherGHI
NYP35981Medicare PIN