Provider Demographics
NPI:1467433904
Name:COOK, JACK B (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:B
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2102
Mailing Address - Country:US
Mailing Address - Phone:516-747-4011
Mailing Address - Fax:516-747-1277
Practice Address - Street 1:305 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2102
Practice Address - Country:US
Practice Address - Phone:516-747-4011
Practice Address - Fax:516-747-1277
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY127282207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY127282OtherHIP
NY00351368Medicaid
NY2C3455OtherHEALTHNET
NY42Z652OtherBLUE CROSS BLUE SHIELD
NY16240OtherVYTRA
NY0098910OtherGHI
NY0344848OtherCIGNA
NYAS708OtherOXFORD
2209991OtherUS HEALTHCARE
NYJC042Z6520OtherGENERIC
NY4313878OtherAETNA
NY42Z652OtherBLUE CROSS BLUE SHIELD
NY00351368Medicaid