Provider Demographics
NPI:1851305445
Name:COBEN, ROBERT ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:COBEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1035 PARK BLVD STE 2B
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2743
Mailing Address - Country:US
Mailing Address - Phone:516-799-8599
Mailing Address - Fax:516-799-4054
Practice Address - Street 1:1035 PARK BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762
Practice Address - Country:US
Practice Address - Phone:516-799-8599
Practice Address - Fax:516-799-4054
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0121601103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V1559Medicare ID - Type Unspecified