Provider Demographics
NPI:1053767145
Name:COHEN, PETER
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 RIVERSIDE DR APT 5D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5232
Mailing Address - Country:US
Mailing Address - Phone:917-597-7171
Mailing Address - Fax:
Practice Address - Street 1:290 RIVERSIDE DR APT 5D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5232
Practice Address - Country:US
Practice Address - Phone:917-597-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist