Provider Demographics
NPI:1063704252
Name:COHEN, ILENE MICHELLE (MS, RD, CDN, CDE)
Entity type:Individual
Prefix:MS
First Name:ILENE
Middle Name:MICHELLE
Last Name:COHEN
Suffix:
Gender:F
Credentials:MS, RD, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 3RD AVE UNIT 7857
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10150-2119
Mailing Address - Country:US
Mailing Address - Phone:917-658-0554
Mailing Address - Fax:208-246-1433
Practice Address - Street 1:33 W 19TH ST STE 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4333
Practice Address - Country:US
Practice Address - Phone:917-658-0554
Practice Address - Fax:208-246-1433
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005703133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered