Provider Demographics
NPI:1891706321
Name:COHEN, KENNETH ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT
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 1:222 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2906
Mailing Address - Country:US
Mailing Address - Phone:914-472-6849
Mailing Address - Fax:914-472-6849
Practice Address - Street 1:222 WESTCHESTER AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-472-6849
Practice Address - Fax:914-472-6849
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1356482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00580158Medicaid
13-329-1817OtherIRS
82A711Medicare ID - Type Unspecified
13-329-1817OtherIRS