Healthcare Provider Details

I. General information

NPI: 1639275662
Provider Name (Legal Business Name): ROBERT JAY COOKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SHREWSBURY ST STE D
HOLDEN MA
01520-1960
US

IV. Provider business mailing address

5 SHREWSBURY ST STE D
HOLDEN MA
01520-1960
US

V. Phone/Fax

Practice location:
  • Phone: 508-829-3800
  • Fax: 508-829-3802
Mailing address:
  • Phone: 508-829-3810
  • Fax: 508-829-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA828
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: