1417362898 NPI number — DR. RACHEL COHEN AUDIOLOGY, LLC

Table of content: (NPI 1417362898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417362898 NPI number — DR. RACHEL COHEN AUDIOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. RACHEL COHEN AUDIOLOGY, LLC
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:
1417362898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13889 FARNESE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESTERO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33928-5702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-997-4045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13889 FARNESE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTERO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33928-5702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-997-4045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MBR/OWNER AUDIOLOGIST
Authorized Official Telephone Number:
202-997-4045

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AY1495 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 004307700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000583700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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