Provider Demographics
NPI:1912924580
Name:GEORGE-COOK, SHIRLEY (CNM)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:GEORGE-COOK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-4920
Mailing Address - Country:US
Mailing Address - Phone:609-484-9142
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-677-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00018301367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5189606Medicaid
NJ672776SBVMedicare PIN
NJ5189606Medicaid
NJ210634549CN9Medicare UPIN
NJR98604Medicare UPIN
NJ020701782SBVMedicare UPIN
NJ020701782Medicare UPIN