Healthcare Provider Details

I. General information

NPI: 1710236872
Provider Name (Legal Business Name): WILLARD H COOK, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 AVENUE AT THE CMN
SHREWSBURY NJ
07702-4806
US

IV. Provider business mailing address

59 AVENUE AT THE CMN
SHREWSBURY NJ
07702-4806
US

V. Phone/Fax

Practice location:
  • Phone: 732-542-7013
  • Fax: 732-542-0991
Mailing address:
  • Phone: 732-542-7013
  • Fax: 732-542-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA02769100
License Number StateNJ

VIII. Authorized Official

Name: LINDA MEYERHOFF
Title or Position: BILLING MGR
Credential:
Phone: 908-237-9092