1790854784 NPI number — DR. PAUL BARTON COHEN DDS

Table of content: DR. PAUL BARTON COHEN DDS (NPI 1790854784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790854784 NPI number — DR. PAUL BARTON COHEN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
PAUL
Provider Middle Name:
BARTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790854784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 ROUTE 70 E
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-751-1808
Provider Business Mailing Address Fax Number:
856-751-7162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 MARLTON PIKE E
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08003-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-751-1808
Provider Business Practice Location Address Fax Number:
856-751-7162
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  22DI00912900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X , with the licence number: DS017404L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16606 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 156944 . This is a "MEDICARE INDIV #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 156944 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 159652 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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