MEDICARE: JOSEPH W. COONEY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1992800569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH W. COONEY, INC

Provider Business Mailing Address
First Line	:	8632 GERMANTOWN AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19118-2841
Country	:	US
Telephone Number	:	215-247-0411
Fax Number	:	215-248-3004

Provider Business Practice Location Address
First Line	:	8632 GERMANTOWN AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19118-2841
Country	:	US
Telephone Number	:	215-247-0411
Fax Number	:	215-248-3004

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. LAUREN M COONEY
Credential	:
Telephone Number	:	215-247-0411

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	06/24/2008

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