Basic Information
| Provider Information | |||||||||
| NPI: | 1043261449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650782 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752650782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425085 | ||||||||
| FaxNumber: | 2156724264 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 W SHERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083606912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566418000 | ||||||||
| FaxNumber: | 2156724264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 009801621 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA08931500 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 43907 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | D0058794 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD09886 | RI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 23574 | SC | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 891333V | 05 | NC | MEDICAID | BC5501425 | 01 | NJ | DEA | OTHER | D09840300 | 01 | NJ | CDS | OTHER |