Provider Demographics
NPI:1245334721
Name:COHEN, ZAZA
Entity type:Individual
Prefix:
First Name:ZAZA
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ZAZA
Other - Middle Name:
Other - Last Name:KOYENISHVILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1253 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 332
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2931
Mailing Address - Country:US
Mailing Address - Phone:973-229-0308
Mailing Address - Fax:
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:MOUNTAINSIDE HOSPITAL, DEPARTMENT OF MEDICINE
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4837
Practice Address - Country:US
Practice Address - Phone:973-429-6874
Practice Address - Fax:973-429-6575
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07622700207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029173Medicaid
NJ074738Medicare ID - Type Unspecified
NJ0029173Medicaid