Healthcare Provider Details

I. General information

NPI: 1992626402
Provider Name (Legal Business Name): ROBERT COOK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HENDRICKSON AVE
BRICK NJ
08724-2574
US

IV. Provider business mailing address

PO BOX 2036
LAKEWOOD NJ
08701-8036
US

V. Phone/Fax

Practice location:
  • Phone: 732-785-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number44SL07189600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: