Provider Demographics
NPI:1255347449
Name:COHEN, MARK JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOEL
Last Name:COHEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 ROCKEFELLER RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-8674
Mailing Address - Country:US
Mailing Address - Phone:315-664-6275
Mailing Address - Fax:
Practice Address - Street 1:4903 ROCKEFELLER RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-8674
Practice Address - Country:US
Practice Address - Phone:315-664-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE15686Medicare UPIN