Provider Demographics
NPI:1205849650
Name:COOLEY, WILLIAM S JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:COOLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4857 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476
Mailing Address - Country:US
Mailing Address - Phone:315-363-9995
Mailing Address - Fax:315-363-9686
Practice Address - Street 1:4857 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476
Practice Address - Country:US
Practice Address - Phone:315-363-9995
Practice Address - Fax:315-363-9686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01182732Medicaid
NY01182732Medicaid
NYE62737Medicare UPIN