Provider Demographics
NPI:1871632042
Name:PROKOSCH-COOK, GINA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:PROKOSCH-COOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 QUASSAICK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6713
Mailing Address - Country:US
Mailing Address - Phone:845-569-8900
Mailing Address - Fax:845-569-8916
Practice Address - Street 1:45 QUASSAICK AVE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-6713
Practice Address - Country:US
Practice Address - Phone:845-569-8900
Practice Address - Fax:845-569-8916
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045579-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02318156Medicaid