Provider Demographics
NPI:1932650405
Name:COHEN, PESHA MIRIAM
Entity Type:Individual
Prefix:
First Name:PESHA
Middle Name:MIRIAM
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PESHI
Other - Middle Name:MIRIAM
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:456 CHESTNUT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6124
Mailing Address - Country:US
Mailing Address - Phone:732-905-9200
Mailing Address - Fax:732-905-4470
Practice Address - Street 1:456 CHESTNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6124
Practice Address - Country:US
Practice Address - Phone:732-905-9200
Practice Address - Fax:732-905-4470
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJF0816137363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner