Provider Demographics
NPI:1013996602
Name:COHEN, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 THIRD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740
Mailing Address - Country:US
Mailing Address - Phone:732-222-2111
Mailing Address - Fax:732-229-8770
Practice Address - Street 1:279 THIRD AVE
Practice Address - Street 2:STE 101
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740
Practice Address - Country:US
Practice Address - Phone:732-222-2111
Practice Address - Fax:732-229-8770
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02273000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3391721Medicaid
F44888Medicare UPIN
NJ168591AGVMedicare PIN
NJP00463197Medicare PIN