Provider Demographics
NPI:1548271539
Name:COHEN, STEPHANIE GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GAIL
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:GAIL
Other - Last Name:BADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1645 TULLIE CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2304
Mailing Address - Country:US
Mailing Address - Phone:732-985-7224
Mailing Address - Fax:
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:MEB THIRD FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0659492080P0204X
NJ25MA07654900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0080616Medicaid
NJ0080616Medicaid
NJ099304CGDMedicare PIN
NJ099304AOZMedicare PIN