Provider Demographics
NPI:1679666903
Name:COBB, WILLIAM ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:COBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W RIVER STYX RD
Mailing Address - Street 2:
Mailing Address - City:HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07843-1828
Mailing Address - Country:US
Mailing Address - Phone:973-398-8900
Mailing Address - Fax:973-398-2498
Practice Address - Street 1:2 W RIVER STYX RD
Practice Address - Street 2:
Practice Address - City:HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07843-1828
Practice Address - Country:US
Practice Address - Phone:973-398-8900
Practice Address - Fax:973-398-2498
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03541900208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1642804Medicaid
NJ453330Medicare ID - Type Unspecified
NJ1642804Medicaid