Provider Demographics
NPI:1477213452
Name:COLE, RICHARD WILSON JR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILSON
Last Name:COLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COWEN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2012
Mailing Address - Country:US
Mailing Address - Phone:929-256-0231
Mailing Address - Fax:
Practice Address - Street 1:20 COWEN PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2012
Practice Address - Country:US
Practice Address - Phone:929-256-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist