Provider Demographics
NPI:1588751861
Name:COHEN, PAUL A (DO, DABFM, FAAFP)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO, DABFM, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SABER DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2834
Mailing Address - Country:US
Mailing Address - Phone:631-360-2726
Mailing Address - Fax:
Practice Address - Street 1:99 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3135
Practice Address - Country:US
Practice Address - Phone:631-366-5800
Practice Address - Fax:631-366-2935
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG35470Medicare UPIN
NY685901Medicare ID - Type Unspecified