| John Cooke, Md, Llc | |
|
516 Bloomfield Ave Suite 4 Montclair NJ 07042-3429 | |
| (973) 509-1500 | |
| (973) 509-1919 |
| Full Name | John Cooke, Md, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 516 Bloomfield Ave, Montclair, New Jersey |
| Authorized Official Name and Position | John Richard Cooke (OWNER/DIRECTOR) |
| Authorized Official Contact | 9737681005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Cooke, Md, Llc 34 Saint Lukes Pl Montclair NJ 07042-2139 Ph: (973) 768-1005 | John Cooke, Md, Llc 516 Bloomfield Ave Suite 4 Montclair NJ 07042-3429 Ph: (973) 509-1500 |
| NPI Number | 1083035497 |
|---|---|
| Provider Enumeration Date | 01/02/2014 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 1759703788 |
|---|---|
| Medicare Enrollment ID | O20200622001078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083035497 | NPI | - | NPPES |
| 8256004 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 25MA07095800 (New Jersey) | Primary |
| Provider Name | John R Cooke |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083895114 PECOS PAC ID: 0244394633 Enrollment ID: I20090129000576 |
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