Provider Demographics
NPI:1427237650
Name:BARRY M. COGEN, D.O., INC
Entity type:Organization
Organization Name:BARRY M. COGEN, D.O., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:COGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-644-3311
Mailing Address - Street 1:2772 JOHNSON DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-644-3311
Mailing Address - Fax:805-644-2161
Practice Address - Street 1:2772 JOHNSON DR
Practice Address - Street 2:SUITE 114
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-644-3311
Practice Address - Fax:805-644-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A55742081S0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13208Medicare PIN