Provider Demographics
NPI:1609953702
Name:COHEN, ADAM DANIEL (DC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DANIEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967
Mailing Address - Country:US
Mailing Address - Phone:631-395-9090
Mailing Address - Fax:631-395-9100
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967
Practice Address - Country:US
Practice Address - Phone:631-395-9090
Practice Address - Fax:631-395-9100
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX0I061Medicare PIN