Provider Demographics
NPI:1891705448
Name:COHEN, LEEBER (MD)
Entity Type:Individual
Prefix:
First Name:LEEBER
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 5TH AVE
Mailing Address - Street 2:STE B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4342
Mailing Address - Country:US
Mailing Address - Phone:212-777-1644
Mailing Address - Fax:212-260-1158
Practice Address - Street 1:11 5TH AVE
Practice Address - Street 2:STE B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4342
Practice Address - Country:US
Practice Address - Phone:212-777-1644
Practice Address - Fax:212-260-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162015207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01008048Medicaid
NY91D721Medicare ID - Type Unspecified
NYA64775Medicare UPIN