Healthcare Provider Details

I. General information

NPI: 1700580123
Provider Name (Legal Business Name): JAY COK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W TECH RD
MIAMISBURG OH
45342-0955
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-885-4475
  • Fax: 937-885-3670
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.155529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: