Provider Demographics
NPI:1104895358
Name:COHEN, STANLEY NEAL (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:NEAL
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 1:3131 LACANADA STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2592
Mailing Address - Country:US
Mailing Address - Phone:702-731-8115
Mailing Address - Fax:702-784-7844
Practice Address - Street 1:3131 LACANADA STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2592
Practice Address - Country:US
Practice Address - Phone:702-731-8115
Practice Address - Fax:702-784-7844
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV116062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507595Medicaid
CAXPY205009Medicaid
NV1104895358Medicaid
CA1104895358Medicaid
UT1104895358Medicaid
AZ976805Medicaid
AZ976805Medicaid
CAXPY205009Medicaid
A91372Medicare UPIN
NV100507595Medicaid
NVV105681Medicare PIN