# PENNSUAKEN FAMILY PRACTICE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518187392
- **Authorized official:** DR. HERMAN P COHEN D.O. (OWNER)
- **Authorized official phone:** (856) 663-1470

## Contact information

- **Practice address:** 5647 WESTFIELD AVE, PENNSAUKEN, NJ 08110-1836
- **Practice address phone:** (856) 663-1470
- **Practice address fax:** (856) 663-3409
- **Mailing address:** 5647 WESTFIELD AVE, PENNSAUKEN, NJ 08110-1836
- **Mailing address phone:** (856) 663-1470
- **Mailing address fax:** (856) 663-3409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 61259 | NJ | Yes |

## Other

- **Enumeration date:** 04/26/2007
- **Last updated:** 05/13/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0964523000 | KEYSTONE | PA |
| 01 | — | 3370 | AETNA | PA |
| 05 | — | 857996 | — | NJ |