Provider Demographics
NPI:1396876488
Name:TERENCE CARDINAL COOKE HEALTH CARE CENTER
Entity type:Organization
Organization Name:TERENCE CARDINAL COOKE HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COVONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-633-4702
Mailing Address - Street 1:1249 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4413
Mailing Address - Country:US
Mailing Address - Phone:212-360-3764
Mailing Address - Fax:212-427-9488
Practice Address - Street 1:1249 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4413
Practice Address - Country:US
Practice Address - Phone:212-360-3764
Practice Address - Fax:212-427-9488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERENCE CARDINAL COOKE HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002345N261Q00000X, 261QD1600X, 314000000X, 261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02522907Medicaid
NY00355202Medicaid
NYA399542OtherOXFORD
NY05281OtherBLUE CROSS BLUE SHIELD PR
NYA399542OtherOXFORD
NY02522907Medicaid
NY5270360001Medicare NSC