Provider Demographics
NPI:1801870241
Name:COHEN, LESLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 POMONA RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-1919
Mailing Address - Country:US
Mailing Address - Phone:917-416-3681
Mailing Address - Fax:845-331-8846
Practice Address - Street 1:186 BROADWAY
Practice Address - Street 2:
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466-7707
Practice Address - Country:US
Practice Address - Phone:845-331-9150
Practice Address - Fax:845-331-8846
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040434-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00989482Medicaid
NYD69301Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY00989482Medicaid