Provider Demographics
NPI:1184223745
Name:COONEY, ELIZABETH A (ATC LAT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:COONEY
Suffix:
Gender:F
Credentials:ATC LAT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:TENORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:28 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3519
Mailing Address - Country:US
Mailing Address - Phone:551-206-9135
Mailing Address - Fax:
Practice Address - Street 1:6 LLOYD RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1707
Practice Address - Country:US
Practice Address - Phone:973-509-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001420002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer