Provider Demographics
NPI:1740354240
Name:COHEN, MICHAEL J (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
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 1:24-26 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3401
Mailing Address - Country:US
Mailing Address - Phone:201-796-0101
Mailing Address - Fax:201-796-8220
Practice Address - Street 1:24-26 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3401
Practice Address - Country:US
Practice Address - Phone:201-796-0101
Practice Address - Fax:201-796-8220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ735030Medicare ID - Type Unspecified
NJT53200Medicare UPIN