Provider Demographics
NPI:1992096796
Name:DR. JASON G. COONEY
Entity type:Organization
Organization Name:DR. JASON G. COONEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-772-5254
Mailing Address - Street 1:241 CROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1614
Mailing Address - Country:US
Mailing Address - Phone:973-772-5254
Mailing Address - Fax:973-772-2701
Practice Address - Street 1:241 CROOKS AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1614
Practice Address - Country:US
Practice Address - Phone:973-772-5254
Practice Address - Fax:973-772-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00586600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty