Provider Demographics
NPI:1649241449
Name:COHEN, GARY GLEN (PT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:GLEN
Last Name:COHEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 OCEAN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3044
Mailing Address - Country:US
Mailing Address - Phone:718-998-7586
Mailing Address - Fax:718-998-3374
Practice Address - Street 1:2350 OCEAN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3044
Practice Address - Country:US
Practice Address - Phone:718-998-7586
Practice Address - Fax:718-998-3374
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004045-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ52642Medicare ID - Type UnspecifiedPHYSICAL THERAPY