Provider Demographics
NPI:1447804083
Name:JON COONEY MD LLC
Entity Type:Organization
Organization Name:JON COONEY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-486-3600
Mailing Address - Street 1:98-211 PALI MOMI ST STE 414
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4318
Mailing Address - Country:US
Mailing Address - Phone:808-486-3600
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 414
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4318
Practice Address - Country:US
Practice Address - Phone:808-486-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health