Provider Demographics
NPI:1740028398
Name:COHEN, MINNA JACQUELINE
Entity type:Individual
Prefix:
First Name:MINNA
Middle Name:JACQUELINE
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16221 POWELLS COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1409
Mailing Address - Country:US
Mailing Address - Phone:718-704-3323
Mailing Address - Fax:
Practice Address - Street 1:3004 146TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2324
Practice Address - Country:US
Practice Address - Phone:718-962-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency