Provider Demographics
NPI:1922491745
Name:COHEN, EVAN ROSS (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ROSS
Last Name:COHEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BEACH 126TH ST
Mailing Address - Street 2:APT #2
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1718
Mailing Address - Country:US
Mailing Address - Phone:347-733-5275
Mailing Address - Fax:
Practice Address - Street 1:1975 HYLAN BLVD., UNIT #2
Practice Address - Street 2:HYLAN DENTAL ARTS
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306
Practice Address - Country:US
Practice Address - Phone:347-733-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0577891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics