Provider Demographics
NPI:1215079181
Name:COHEN, SUSAN (CP, ATC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:CP, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 MERRICK RD STE LL2
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5546
Mailing Address - Country:US
Mailing Address - Phone:516-678-3650
Mailing Address - Fax:
Practice Address - Street 1:556 MERRICK RD STE LL2
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5546
Practice Address - Country:US
Practice Address - Phone:516-678-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2255A2300X
224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer