Provider Demographics
NPI:1144583659
Name:COOK, LEVERNE
Entity Type:Individual
Prefix:MS
First Name:LEVERNE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEVERNE
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:535 8TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4305
Mailing Address - Country:US
Mailing Address - Phone:212-787-9700
Mailing Address - Fax:212-787-4418
Practice Address - Street 1:535 8TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4305
Practice Address - Country:US
Practice Address - Phone:212-787-9700
Practice Address - Fax:212-787-4418
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664008961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY664008961OtherSTATE CERTIFICATION