Healthcare Provider Details

I. General information

NPI: 1912324872
Provider Name (Legal Business Name): PATRICIA COOKE CDN,CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-13 169TH STREET
FLUSHING NY
11358
US

IV. Provider business mailing address

41-13 169TH STREET
FLUSHING NY
11358
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-8704
  • Fax:
Mailing address:
  • Phone: 718-358-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number008044-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: