Provider Demographics
NPI:1972647246
Name:COHEN, JACK (DPM)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:524 ARTHUR GODFREY RD
Mailing Address - Street 2:STE 204
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3520
Mailing Address - Country:US
Mailing Address - Phone:786-276-3668
Mailing Address - Fax:305-535-1004
Practice Address - Street 1:524 ARTHUR GODFREY RD
Practice Address - Street 2:STE 204
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3520
Practice Address - Country:US
Practice Address - Phone:786-276-3668
Practice Address - Fax:305-535-1004
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO1663213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery