Provider Demographics
NPI:1245639681
Name:COOLEY, MAILE
Entity type:Individual
Prefix:
First Name:MAILE
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 CHATTERTON AVE # 2B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-6203
Mailing Address - Country:US
Mailing Address - Phone:917-741-2050
Mailing Address - Fax:
Practice Address - Street 1:2159 CHATTERTON AVE # 2B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-6203
Practice Address - Country:US
Practice Address - Phone:917-741-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318949164W00000X
FLPN5199414164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse