Healthcare Provider Details

I. General information

NPI: 1376454025
Provider Name (Legal Business Name): PAUL KOONER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CORNELIA STREET
PLATTSBURGH NY
12901-2779
US

IV. Provider business mailing address

209 CORNELIA STREET
PLATTSBURGH NY
12901-2779
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-5516
  • Fax: 518-563-7421
Mailing address:
  • Phone: 518-561-5516
  • Fax: 518-563-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: