Basic Information
Provider Information | |||||||||
NPI: | 1073551800 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COHEN | ||||||||
FirstName: | BARRY | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 4059 | ||||||||
Address2: |   | ||||||||
City: | WAYNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 074744059 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9738268285 | ||||||||
FaxNumber: | 8558345436 | ||||||||
Practice Location | |||||||||
Address1: | 695 US HIGHWAY 46 | ||||||||
Address2: | SUITE 400A | ||||||||
City: | FAIRFIELD | ||||||||
State: | NJ | ||||||||
PostalCode: | 070041592 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9738268080 | ||||||||
FaxNumber: | 8663093354 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/03/2006 | ||||||||
LastUpdateDate: | 09/28/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MA0291500 | NJ | N |   | Other Service Providers | Specialist |   | 207VG0400X | 25MA02915000 | NJ | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 208600000X | ME119433 | FL | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 25MA02915000 | NJ | Y |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 125434 | NY | N |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 0660302 | 05 | NJ |   | MEDICAID | P3942465 | 01 | NJ | OXFORD HEALTHCARE | OTHER | 146573YP69 | 01 | NJ | GRP PTAN QUALITY SURGICAL SERVICES LLC | OTHER | 275286YP69 | 01 | NJ | BAC MCARE PIN | OTHER | 3740947000 | 01 | NJ | AMERIHEALTH | OTHER | 0543004 | 01 | NJ | CIGNA | OTHER |