1184605545 NPI number — DR. STEPHEN COHEN M.D., PA-C

Table of content: DR. STEPHEN COHEN M.D., PA-C (NPI 1184605545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184605545 NPI number — DR. STEPHEN COHEN M.D., PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
STEPHEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184605545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1995 E OAKLAND PARK BLVD STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33306-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-791-6146
Provider Business Mailing Address Fax Number:
954-337-2733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 N FLAMINGO RD
Provider Second Line Business Practice Location Address:
DEPT OF SURGERY
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33028-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-436-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA2980 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: PA2980 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA2980 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 292961900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104009900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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