Healthcare Provider Details

I. General information

NPI: 1467431049
Provider Name (Legal Business Name): TONYA X COOK D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 KEARNY AVE
PERTH AMBOY NJ
08861-4700
US

IV. Provider business mailing address

149 KEARNY AVE
PERTH AMBOY NJ
08861-4700
US

V. Phone/Fax

Practice location:
  • Phone: 732-293-0135
  • Fax: 732-293-0139
Mailing address:
  • Phone: 732-293-0135
  • Fax: 732-293-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20369
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: