Healthcare Provider Details

I. General information

NPI: 1487082855
Provider Name (Legal Business Name): MR. ALAN A COOK III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GENESEE ST
AVON NY
14414-1216
US

IV. Provider business mailing address

117 FRANKLIN ST STE 300
DANSVILLE NY
14437-1044
US

V. Phone/Fax

Practice location:
  • Phone: 585-226-3040
  • Fax: 732-847-3364
Mailing address:
  • Phone: 585-335-3040
  • Fax: 585-204-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1017
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number03-0000236
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000046412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: