Provider Demographics
NPI:1265920672
Name:ANDREW T COHEN A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ANDREW T COHEN A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ORNITZ
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-659-8771
Mailing Address - Street 1:9400 BRIGHTON WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4709
Mailing Address - Country:US
Mailing Address - Phone:310-659-8771
Mailing Address - Fax:310-388-5222
Practice Address - Street 1:9400 BRIGHTON WAY STE 201
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4709
Practice Address - Country:US
Practice Address - Phone:310-659-8771
Practice Address - Fax:310-388-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA562232086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841367208OtherBLUE SHIELD