Provider Demographics
NPI:1851663348
Name:LEON A COHEN, M.D. PA
Entity type:Organization
Organization Name:LEON A COHEN, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-453-3420
Mailing Address - Street 1:375 S COURTENAY PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4868
Mailing Address - Country:US
Mailing Address - Phone:321-453-3420
Mailing Address - Fax:321-453-8262
Practice Address - Street 1:375 S COURTENAY PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4868
Practice Address - Country:US
Practice Address - Phone:321-453-3420
Practice Address - Fax:321-453-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046926200Medicaid
FLFT326AMedicare PIN