Provider Demographics
NPI:1124091442
Name:COOK, HEATHER T (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:T
Last Name:COOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4509
Mailing Address - Country:US
Mailing Address - Phone:718-792-7600
Mailing Address - Fax:718-792-1074
Practice Address - Street 1:3251 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4509
Practice Address - Country:US
Practice Address - Phone:718-792-7600
Practice Address - Fax:718-792-1074
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01991937Medicaid
G48804Medicare UPIN
NY542171Medicare ID - Type Unspecified