Provider Demographics
NPI:1649374802
Name:COHEN, ILAN (MD)
Entity type:Individual
Prefix:DR
First Name:ILAN
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-456-9500
Mailing Address - Fax:718-497-8762
Practice Address - Street 1:5650 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1138
Practice Address - Country:US
Practice Address - Phone:718-456-9500
Practice Address - Fax:718-497-8762
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA072656207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8550107Medicaid
NYX92888Medicare UPIN
NY444A71Medicare PIN
NJ8550107Medicaid
NJ049222Medicare ID - Type Unspecified