Provider Demographics
NPI:1992119093
Name:COHEN, IAN JORDAN
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:JORDAN
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10848 70TH RD
Mailing Address - Street 2:APT 7E
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3937
Mailing Address - Country:US
Mailing Address - Phone:215-990-2141
Mailing Address - Fax:
Practice Address - Street 1:10848 70TH RD
Practice Address - Street 2:APT 7E
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3937
Practice Address - Country:US
Practice Address - Phone:215-990-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018091103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist