Provider Demographics
NPI:1265530968
Name:COHEN, GWEN STACEY (DDS)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:STACEY
Last Name:COHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 RAMAPO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1199
Mailing Address - Country:US
Mailing Address - Phone:201-828-9188
Mailing Address - Fax:201-828-9189
Practice Address - Street 1:156 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1199
Practice Address - Country:US
Practice Address - Phone:201-828-9188
Practice Address - Fax:201-828-9189
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 203031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics