Provider Demographics
NPI:1295731305
Name:COHEN, LARRY J (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:98 JAMES ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-635-0916
Mailing Address - Fax:732-494-4907
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:STE 313
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-635-0916
Practice Address - Fax:732-494-4907
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04122700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1653806Medicaid
NJD77312Medicare UPIN
NJ34473ADCMedicare ID - Type Unspecified