Provider Demographics
NPI:1447259353
Name:COHEN, JEFFREY R (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-2019
Mailing Address - Country:US
Mailing Address - Phone:330-426-9484
Mailing Address - Fax:330-426-2248
Practice Address - Street 1:132 N MARKET ST
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-2019
Practice Address - Country:US
Practice Address - Phone:330-426-9484
Practice Address - Fax:330-426-2248
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400962Medicaid
OH9269141Medicare PIN
OHC01679Medicare UPIN
OH9269142Medicare PIN
OH9269143Medicare PIN