MEDICARE: EILEEN MARIE COOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1215273008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN MARIE COOK

Provider Business Mailing Address
First Line	:	502 VICTORY CIR
Second Line	:
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-2306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 WOODLAWN AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2162
Country	:	US
Telephone Number	:	518-584-7460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2012
Last Update Date	:	12/24/2012

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