Provider Demographics
NPI:1457454092
Name:COHEN, JEFFREY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19-21 FAIR LAWN AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2331
Mailing Address - Country:US
Mailing Address - Phone:201-796-7772
Mailing Address - Fax:201-794-8818
Practice Address - Street 1:19-21 FAIR LAWN AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2331
Practice Address - Country:US
Practice Address - Phone:201-796-7772
Practice Address - Fax:201-794-8818
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00219900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
223205803OtherTAX ID NUMBER
U24664Medicare UPIN
NJ542797TREMedicare ID - Type Unspecified