Healthcare Provider Details

I. General information

NPI: 1336784255
Provider Name (Legal Business Name): JENNIFER MARIE COOK HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 WEHRLE DR
BUFFALO NY
14225-1081
US

IV. Provider business mailing address

115 ROUTE 46 STE G51
MOUNTAIN LAKES NJ
07046-1676
US

V. Phone/Fax

Practice location:
  • Phone: 716-837-6213
  • Fax:
Mailing address:
  • Phone: 973-588-7266
  • Fax: 973-968-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000059364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: