Provider Demographics
NPI:1952621013
Name:COHEN, SHIMON L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIMON
Middle Name:L
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 W TERRACE CIR
Mailing Address - Street 2:APT 3
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5229
Mailing Address - Country:US
Mailing Address - Phone:718-673-0584
Mailing Address - Fax:
Practice Address - Street 1:1474 W TERRACE CIR
Practice Address - Street 2:APT 3
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5229
Practice Address - Country:US
Practice Address - Phone:718-673-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266251207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program