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General NPI Number Information
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NPI Number | 1841318763
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Entity Type | Organization
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Legal Business Name | RANDOLPH B. COOKE MD
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 596 5TH AVE
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City | OWEGO
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State | NY
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Zip | 13827-1629
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Country | US
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Telephone | 607-687-7141
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Fax | 607-687-2224
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Provider Business Mailing Address
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Address Line | 596 5TH AVE
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City | OWEGO
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State | NY
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Zip | 13827-1629
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Country | US
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Telephone | 607-687-7141
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Fax | 607-687-2224
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DUSTY KINNEY
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Credential |
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Telephone | 607-687-7141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 116682
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License Number State | NY
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