Provider Demographics
NPI:1548488810
Name:HARVEY D. COHEN M.D., INC.
Entity type:Organization
Organization Name:HARVEY D. COHEN M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-987-1730
Mailing Address - Street 1:PO BOX 4049
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-4049
Mailing Address - Country:US
Mailing Address - Phone:909-987-2528
Mailing Address - Fax:909-987-4668
Practice Address - Street 1:8330 RED OAK ST STE 201
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0603
Practice Address - Country:US
Practice Address - Phone:909-987-2528
Practice Address - Fax:909-987-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27464Medicare UPIN
CAZZZ23645ZMedicare ID - Type Unspecified