Provider Demographics
NPI:1538161849
Name:COHEN, TERRENCE JAY (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:JAY
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1024
Mailing Address - Country:US
Mailing Address - Phone:561-641-6769
Mailing Address - Fax:
Practice Address - Street 1:133 TURNBERRY DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1024
Practice Address - Country:US
Practice Address - Phone:561-641-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57102OtherUPIN NUMBER
FL0663212-00Medicaid
FLD57102OtherUPIN NUMBER