Provider Demographics
NPI:1740638931
Name:COHEN, DANIEL ADAM (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ADAM
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:75 W RED BANK AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1694
Mailing Address - Country:US
Mailing Address - Phone:856-853-2055
Mailing Address - Fax:856-848-2879
Practice Address - Street 1:1165 CENTRE TURPIKE
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961
Practice Address - Country:US
Practice Address - Phone:272-639-5130
Practice Address - Fax:272-639-5152
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD468244207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program