Provider Demographics
NPI:1548925647
Name:CHRISTINE COOLEY FAMILY HEALTH, NP, PLLC
Entity type:Organization
Organization Name:CHRISTINE COOLEY FAMILY HEALTH, NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:518-669-3245
Mailing Address - Street 1:500 FEDERAL ST STE 650
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2867
Mailing Address - Country:US
Mailing Address - Phone:518-441-8720
Mailing Address - Fax:518-278-4057
Practice Address - Street 1:500 FEDERAL ST STE 650
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2867
Practice Address - Country:US
Practice Address - Phone:518-441-8720
Practice Address - Fax:518-278-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02326543Medicaid
NY1548925647OtherNGS.MEDICARE