Provider Demographics
NPI:1225727803
Name:CAROLYN COOK WELLNESS LLC
Entity Type:Organization
Organization Name:CAROLYN COOK WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:631-741-0143
Mailing Address - Street 1:199 BELLPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2219
Mailing Address - Country:US
Mailing Address - Phone:631-741-0143
Mailing Address - Fax:
Practice Address - Street 1:861 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1613
Practice Address - Country:US
Practice Address - Phone:631-472-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty