Provider Demographics
NPI:1154585743
Name:COHEN, PETA (RD)
Entity type:Individual
Prefix:
First Name:PETA
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N DEAN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2804
Mailing Address - Country:US
Mailing Address - Phone:201-541-7601
Mailing Address - Fax:201-541-7876
Practice Address - Street 1:11 N DEAN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2804
Practice Address - Country:US
Practice Address - Phone:201-541-7601
Practice Address - Fax:201-541-7876
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ853204133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic