Provider Demographics
NPI:1427359629
Name:COOKE, MARY GH
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GH
Last Name:COOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4238
Mailing Address - Country:US
Mailing Address - Phone:718-575-0300
Mailing Address - Fax:718-575-3559
Practice Address - Street 1:6915 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4238
Practice Address - Country:US
Practice Address - Phone:718-575-0300
Practice Address - Fax:718-575-3559
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4249171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist