Provider Demographics
NPI:1982609830
Name:COHEN, JAY M (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 MORRIS AVE #2
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083
Mailing Address - Country:US
Mailing Address - Phone:908-624-0200
Mailing Address - Fax:908-760-8979
Practice Address - Street 1:2235 MORRIS AVE #2
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-624-0200
Practice Address - Fax:908-760-8979
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2017-11-09
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-05-10
Provider Licenses
StateLicense IDTaxonomies
NJ3792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJUO2021Medicare UPIN