MEDICARE: EMMA S COOKE ND

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	175F00000X	Naturopath	000625	CT

General Provider Information

NPI Number	:	1316419732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA S COOKE ND

Provider Business Mailing Address
First Line	:	35 W BROAD ST UNIT 103
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 BLACK ROCK TPKE
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-3546
Country	:	US
Telephone Number	:	914-582-5084
Fax Number	:

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

Provider Enumeration Date	:	12/24/2018
Last Update Date	:	12/24/2018

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