Provider Demographics
NPI:1174956593
Name:COHEN, JEREMY L (DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:L
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3476
Mailing Address - Country:US
Mailing Address - Phone:908-252-0242
Mailing Address - Fax:908-252-0243
Practice Address - Street 1:3322 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-252-0242
Practice Address - Fax:908-252-0243
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036684225100000X
NJ40QA01552800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist