Healthcare Provider Details

I. General information

NPI: 1841274370
Provider Name (Legal Business Name): WILLARD H COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 AVE AT THE COMMON
SHREWSBURY NJ
07702-4806
US

IV. Provider business mailing address

PO BOX 8519
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-542-7010
  • Fax: 732-542-0991
Mailing address:
  • Phone: 732-460-9840
  • Fax: 732-460-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: