Provider Demographics
NPI:1215992011
Name:COLLADO-COCKE, ANNA ALTAGRACIA (DO)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:ALTAGRACIA
Last Name:COLLADO-COCKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ALTAGRACIA
Other - Last Name:COLLADO-COCKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:150 OVERLOOK AVENUE
Mailing Address - Street 2:OFFICE #1
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-342-1191
Mailing Address - Fax:201-342-1195
Practice Address - Street 1:150 OVERLOOK AVENUE
Practice Address - Street 2:OFFICE #1
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-342-1191
Practice Address - Fax:201-342-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52499207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5214009Medicaid
NJ726175DQ6Medicare ID - Type Unspecified
NJ5214009Medicaid