Provider Demographics
NPI:1144517160
Name:BRIAN D. COHEN, M.D., PLLC
Entity type:Organization
Organization Name:BRIAN D. COHEN, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-472-4700
Mailing Address - Street 1:560 NORTHERN BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5118
Mailing Address - Country:US
Mailing Address - Phone:516-773-4200
Mailing Address - Fax:
Practice Address - Street 1:560 NORTHERN BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5118
Practice Address - Country:US
Practice Address - Phone:516-773-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2385832086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty