Provider Demographics
NPI:1649300096
Name:COHN, LORRAINE SUSAN (OTR)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:SUSAN
Last Name:COHN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RUSSELL PARK RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5414
Mailing Address - Country:US
Mailing Address - Phone:516-644-5618
Mailing Address - Fax:
Practice Address - Street 1:BEACON THERAPY SERVICES PLLC
Practice Address - Street 2:1441 NORTHERN BLVD.
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576
Practice Address - Country:US
Practice Address - Phone:516-625-6846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003804OtherOTR
NY000000548875OtherAOTA MEMBERSHIP