Provider Demographics
NPI:1841170578
Name:KOHENBASH, AYELET
Entity type:Individual
Prefix:
First Name:AYELET
Middle Name:
Last Name:KOHENBASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WOOLEYS LN APT 2A
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2123
Mailing Address - Country:US
Mailing Address - Phone:718-688-4747
Mailing Address - Fax:
Practice Address - Street 1:1000 RIVER RD STE 2
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1996
Practice Address - Country:US
Practice Address - Phone:201-692-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY963166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse