Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 7792 | NY |
Y | 111NN0400X | Neurology | 007792 | NY |
NPI | 1669449468 |
---|---|
Provider Name | Dr. Scott David Coon |
First Address | E Rochester, NY 14445-2201 |
Second Address | E Rochester, NY 14445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 04/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02117788 | (05) | NY |
U53467 | (02) | NY |