Provider Demographics
NPI:1952527921
Name:JAY L. COHEN, MD, PC
Entity Type:Organization
Organization Name:JAY L. COHEN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-449-3588
Mailing Address - Street 1:464 HILLSIDE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1227
Mailing Address - Country:US
Mailing Address - Phone:781-449-3588
Mailing Address - Fax:781-449-5474
Practice Address - Street 1:464 HILLSIDE AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1227
Practice Address - Country:US
Practice Address - Phone:781-449-3588
Practice Address - Fax:781-449-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20119Medicare ID - Type Unspecified