Provider Demographics
NPI:1841337714
Name:COHEN, SUSAN R (PHD, RN, CS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:COHEN
Suffix:
Gender:F
Credentials:PHD, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOUTH FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-887-2382
Mailing Address - Fax:516-887-2382
Practice Address - Street 1:110 SOUTH FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:516-887-2382
Practice Address - Fax:516-887-2382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146054364S00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R00071Medicare PIN