Basic Information
| Provider Information | |||||||||
| NPI: | 1164405809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | HAIM | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 637783 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452637783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534749 | ||||||||
| FaxNumber: | 5138534740 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 SMITH RD | ||||||||
| Address2: | STE B | ||||||||
| City: | NORWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132214848 | ||||||||
| FaxNumber: | 5138727825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 07/01/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0000X | 36003318C | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ES0103X | 36003318C | OH | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 36003318C | OH | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2399668 | 05 | OH | MEDICAID |