Healthcare Provider Details

I. General information

NPI: 1770406175
Provider Name (Legal Business Name): JESSICA SARAH COOK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 50TH AVE FL 1
LONG ISLAND CITY NY
11101-6297
US

IV. Provider business mailing address

121 DOBBIN ST APT 1L
BROOKLYN NY
11222-2880
US

V. Phone/Fax

Practice location:
  • Phone: 917-725-0207
  • Fax:
Mailing address:
  • Phone: 917-923-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: