Provider Demographics
NPI:1467570028
Name:COLE, JAMES JAY (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JAY
Last Name:COLE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:J
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PHD
Mailing Address - Street 1:1672 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-452-9570
Mailing Address - Fax:518-452-9688
Practice Address - Street 1:1672 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-452-9570
Practice Address - Fax:518-452-9688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181250208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0340812Medicaid
F30025Medicare UPIN
NY0340812Medicaid