Provider Demographics
NPI:1992267322
Name:COOK, ANDREW MCCORMICK (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MCCORMICK
Last Name:COOK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 JUSTICE AVE STE C8
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4590
Mailing Address - Country:US
Mailing Address - Phone:718-424-0339
Mailing Address - Fax:929-367-2522
Practice Address - Street 1:8708 JUSTICE AVE STE C8
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4590
Practice Address - Country:US
Practice Address - Phone:718-424-0339
Practice Address - Fax:929-367-2522
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023445363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty