Provider Demographics
NPI:1962549618
Name:COHEN, JEFFREY R (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:158 W 27TH ST
Mailing Address - Street 2:11TH FL.SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-563-2497
Mailing Address - Fax:212-563-0605
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:4TH FL. CHC BLDG
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5842
Practice Address - Fax:718-485-6370
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1182772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00675021Medicaid
NY20F421Medicare ID - Type UnspecifiedMEDICARE
NY00675021Medicaid