Provider Demographics
NPI:1528148517
Name:COHEN, LISA MARLO (DC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARLO
Last Name:COHEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 ROUTE 88
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2371
Mailing Address - Country:US
Mailing Address - Phone:732-785-5928
Mailing Address - Fax:732-785-5585
Practice Address - Street 1:1451 ROUTE 88
Practice Address - Street 2:SUITE 5
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2371
Practice Address - Country:US
Practice Address - Phone:732-785-5928
Practice Address - Fax:732-785-5585
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0038MC00452200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU69128Medicare UPIN
NJ00006416Medicare ID - Type Unspecified