Provider Demographics
NPI:1124245212
Name:COHEN, KENNETH BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BENJAMIN
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:HA GOEL STREET 1
Mailing Address - Street 2:6
Mailing Address - City:EFRAT
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:90435
Mailing Address - Country:IL
Mailing Address - Phone:0119722-993-3927
Mailing Address - Fax:0119722-993-3927
Practice Address - Street 1:EFRAT MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:EFRAT
Practice Address - State:ISRAEL
Practice Address - Zip Code:90435
Practice Address - Country:IL
Practice Address - Phone:0119722-993-3020
Practice Address - Fax:0119722-993-3017
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine