Provider Demographics
NPI:1194988667
Name:COHEN, STEPHEN (LAC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E 22ND ST
Mailing Address - Street 2:#21
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4603
Mailing Address - Country:US
Mailing Address - Phone:917-499-6388
Mailing Address - Fax:
Practice Address - Street 1:251 5TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6515
Practice Address - Country:US
Practice Address - Phone:917-499-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-05
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003835171100000X
CT000445171100000X
VA0121000509171100000X
IN84000101A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist