Basic Information
Provider Information
NPI: 1326062753
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COHEN
FirstName: ALAN
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 E 42ND ST FL 9
Address2:  
City: NEW YORK
State: NY
PostalCode: 100175699
CountryCode: US
TelephoneNumber: 6466058186
FaxNumber:  
Practice Location
Address1: 17 E 102ND ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100295204
CountryCode: US
TelephoneNumber: 2122417968
FaxNumber: 2128242312
Other Information
ProviderEnumerationDate: 07/27/2006
LastUpdateDate: 05/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X173164NYY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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