Provider Demographics
NPI:1184693335
Name:COHEN, MADELINE (OD)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BARK LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3301
Mailing Address - Country:US
Mailing Address - Phone:631-262-0479
Mailing Address - Fax:631-262-0479
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3972
Practice Address - Country:US
Practice Address - Phone:631-223-0400
Practice Address - Fax:631-421-2689
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02632442Medicaid
NY02632442Medicaid
NYU50885Medicare UPIN