Healthcare Provider Details

I. General information

NPI: 1124091442
Provider Name (Legal Business Name): HEATHER T COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 WESTCHESTER AVE
BRONX NY
10461-4509
US

IV. Provider business mailing address

3251 WESTCHESTER AVE
BRONX NY
10461-4509
US

V. Phone/Fax

Practice location:
  • Phone: 718-792-7600
  • Fax: 718-792-1074
Mailing address:
  • Phone: 718-792-7600
  • Fax: 718-792-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number206069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: