Provider Demographics
NPI:1891751913
Name:COEN, JEFFERY R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:R
Last Name:COEN
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 1:19 DEHON ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3220
Mailing Address - Country:US
Mailing Address - Phone:781-284-5954
Mailing Address - Fax:
Practice Address - Street 1:294 WASHINGTON ST
Practice Address - Street 2:SUITE 217
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4634
Practice Address - Country:US
Practice Address - Phone:617-426-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1645213E00000X, 213ES0131X
MAPD 1645213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70711OtherMEDICARE
MA339554OtherBC/BS DME
MA0344907Medicaid
MA339554OtherBC/BS DME
MAT57928Medicare UPIN