Basic Information
| Provider Information | |||||||||
| NPI: | 1063711729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILLIMAN COHEN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | ISABEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COHEN | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | ISABEL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 42 E LAUREL RD STE 1100 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565667036 | ||||||||
| FaxNumber: | 8565666108 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 E LAUREL RD STE 1100 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565667036 | ||||||||
| FaxNumber: | 8565666108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2011 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080C0008X | 25MA10312100 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics | 2080C0008X | LP03402 | RI | N | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics | 208000000X | 25MA10312100 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0647233 | 05 | NJ | MEDICAID |