Active NPI
Jack E Cohen, DO
- Orthopaedic Surgery Physician
- Orange Park, FL
National Provider Identifier
1720084577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- OS0005009
- Practice address
- 1555 Kingsley Ave
Ste 201
Orange Park, FL 32073-9202 - Phone
- (904) 278-0432
- Fax
- (904) 278-0612
- NPI assigned
- Jun 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | OS0005009 | FL | Primary |
Addresses
Primary practice location
1555 Kingsley Ave
Ste 201
Orange Park, FL 32073-9202
Mailing address
1555 Kingsley Ave
Ste 201
Orange Park, FL 32073-9202
Phone (904) 278-0432
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS0005009 | FL | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Shore Hma Medical Group LLC | Orthopaedic Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258070400000",
"number": "1720084577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1555 KINGSLEY AVE",
"address_2": "STE 201",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320739202",
"telephone_number": "904-278-0432",
"fax_number": "904-278-0612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 KINGSLEY AVE",
"address_2": "STE 201",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320739202",
"telephone_number": "904-278-0432",
"fax_number": "904-278-0612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COHEN",
"first_name": "JACK",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-27",
"last_updated": "2009-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "FL",
"license": "OS0005009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.