Provider Demographics
NPI:1083895114
Name:COOKE, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:COOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:516 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3429
Mailing Address - Country:US
Mailing Address - Phone:973-509-1500
Mailing Address - Fax:973-509-1919
Practice Address - Street 1:516 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3429
Practice Address - Country:US
Practice Address - Phone:973-509-1500
Practice Address - Fax:973-509-1919
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2015-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA070958002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8256004Medicaid