Healthcare Provider Details

I. General information

NPI: 1093976466
Provider Name (Legal Business Name): KRISTIN COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST STE 102
HACKENSACK NJ
07601-3244
US

IV. Provider business mailing address

211 ESSEX ST STE 201
HACKENSACK NJ
07601-3231
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-2144
  • Fax:
Mailing address:
  • Phone: 201-487-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA09319700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: