Provider Demographics
NPI:1083035497
Name:JOHN COOKE, MD, LLC
Entity type:Organization
Organization Name:JOHN COOKE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-768-1005
Mailing Address - Street 1:34 SAINT LUKES PL
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2139
Mailing Address - Country:US
Mailing Address - Phone:973-768-1005
Mailing Address - Fax:973-509-1919
Practice Address - Street 1:516 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3429
Practice Address - Country:US
Practice Address - Phone:973-509-1500
Practice Address - Fax:973-509-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA070958002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8256004Medicaid
NJFC0110584OtherDEA
NJ038667Medicare PIN