Healthcare Provider Details

I. General information

NPI: 1598744146
Provider Name (Legal Business Name): TERENCE CARDINAL COOKE HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 5TH AVENUE
NEW YORK NY
10029
US

IV. Provider business mailing address

1249 5TH AVE
NEW YORK NY
10029-4413
US

V. Phone/Fax

Practice location:
  • Phone: 646-633-4702
  • Fax: 646-633-4701
Mailing address:
  • Phone: 646-633-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7002345N
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNY

VIII. Authorized Official

Name: ANNMARIE COVONE
Title or Position: SR VP CFO
Credential:
Phone: 646-633-4702