1750503363 NPI number — BENJAMIN N COHEN PHD PA

Table of content: (NPI 1750503363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750503363 NPI number — BENJAMIN N COHEN PHD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENJAMIN N COHEN PHD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1750503363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARPON SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34688-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-271-3112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S PINELLAS AVE
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
TARPON SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34689-1955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-271-3112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
727-271-3112

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  PY7056 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 292384 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 262432 . This is a "COMPSYCH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 74425 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7247804 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 328173 . This is a "WELLCARE HARMONY BEH H" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5628593 . This is a "FIRST HEALTH CCN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 768516500 . 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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