Provider Demographics
NPI:1457751059
Name:COHEN, ELIE NATAN (PHD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:NATAN
Last Name:COHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 W BROADWAY STE 5
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1923
Mailing Address - Country:US
Mailing Address - Phone:516-558-3010
Mailing Address - Fax:
Practice Address - Street 1:1226 W BROADWAY STE 5
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1923
Practice Address - Country:US
Practice Address - Phone:516-558-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical