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General NPI Number Information
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NPI Number | 1083035497
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Entity Type | Organization
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Legal Business Name | JOHN COOKE, MD, LLC
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 516 BLOOMFIELD AVE SUITE 4
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3429
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Country | US
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Telephone | 973-509-1500
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Fax | 973-509-1919
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Provider Business Mailing Address
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Address Line | 34 SAINT LUKES PL
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2139
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Country | US
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Telephone | 973-768-1005
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Fax | 973-509-1919
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. JOHN RICHARD COOKE
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Credential | M.D.
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Telephone | 973-768-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA07095800
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License Number State | NJ
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