Provider Demographics
NPI:1255484788
Name:COOK, VICTORIA (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 NESCONSET HWY
Mailing Address - Street 2:SUITE 238
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2037
Mailing Address - Country:US
Mailing Address - Phone:631-928-3122
Mailing Address - Fax:631-928-3192
Practice Address - Street 1:5505 NESCONSET HWY
Practice Address - Street 2:SUITE 238
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2037
Practice Address - Country:US
Practice Address - Phone:631-928-3122
Practice Address - Fax:631-928-3192
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400458363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187671Medicaid
NY2E7821Medicare ID - Type Unspecified
NYS57173Medicare UPIN