Provider Demographics
NPI:1881952539
Name:COHEN, JILLIAN LAURA (MD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LAURA
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5792
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:19 DAVIS AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4488
Practice Address - Country:US
Practice Address - Phone:732-263-7999
Practice Address - Fax:732-242-6688
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281039207Q00000X, 207Q00000X
NJ25MA11222800202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY00695941Medicaid
NY331009Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification