Provider Demographics
NPI:1497793491
Name:COOK, CAROL A (MSRDCDN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:COOK
Suffix:
Gender:F
Credentials:MSRDCDN
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:COOK M.S.R.D.CDN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSRDCDN
Mailing Address - Street 1:2711 HENRY HUDSON PKWY
Mailing Address - Street 2:6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4713
Mailing Address - Country:US
Mailing Address - Phone:914-423-9800
Mailing Address - Fax:
Practice Address - Street 1:2600 NETHERLAND AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4801
Practice Address - Country:US
Practice Address - Phone:718-549-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003157-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered