Provider Demographics
NPI:1366720542
Name:COHEN, ALAN R (OD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ROOSEVLT FIELD MALL
Mailing Address - Street 2:630 OLD COUNTRY ROAD
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3467
Mailing Address - Country:US
Mailing Address - Phone:516-294-0011
Mailing Address - Fax:516-294-2916
Practice Address - Street 1:ROOSEVLT FIELD MALL
Practice Address - Street 2:630 OLD COUNTRY ROAD
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3467
Practice Address - Country:US
Practice Address - Phone:516-294-0011
Practice Address - Fax:516-294-2916
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist