Basic Information
| Provider Information | |||||||||
| NPI: | 1609532548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | KATHLEENA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22581 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100872581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566696050 | ||||||||
| FaxNumber: | 8565283117 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 AMARA LANE | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093460137 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2021 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NJ01228900 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 261QP2300X | 26NJ01228900 | NJ | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.