Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | DPM00368 | RI |
NPI | 1033615125 |
---|---|
Provider Name | Dr. Jay Cooke Emlen JR. |
First Address | Pawtucket, RI 02860-6157 |
Second Address | Dartmouth, MA 02747-1242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2018 |
Last Update Date | 23/08/2021 |