=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538209416
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FREDA B HOOK PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 12/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 OLD HOOK RD SUITE200
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07675-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-664-0201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 370 GREENWICH ST
-----------------------------------------------------
City | BERGENFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07621-3604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-664-0188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 005591
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------