Provider Demographics
NPI:1013279546
Name:COHEN, EVAN PAUL I (MS SPECIAL ED)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:PAUL
Last Name:COHEN
Suffix:I
Gender:M
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEMPSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1208
Mailing Address - Country:US
Mailing Address - Phone:631-678-7882
Mailing Address - Fax:
Practice Address - Street 1:6 HEMPSTEAD ST
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1208
Practice Address - Country:US
Practice Address - Phone:631-678-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY836245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY174400000XOther17 OTHER SSERVICE PROVIDERS, TEACHER