Individual
JACK B COOK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
305 HILLSIDE AVE, WILLISTON PARK, NY 11596-2102
(516) 747-4011
(516) 747-1277
Mailing address
305 HILLSIDE AVE, WILLISTON PARK, NY 11596-2102
(516) 747-4011
(516) 747-1277
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
127282
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00351368
—
NY
01
—
0098910
GHI
NY
01
—
0344848
CIGNA
NY
01
—
127282
HIP
NY
01
—
16240
VYTRA
NY
01
—
2209991
US HEALTHCARE
—
01
—
2C3455
HEALTHNET
NY
01
—
42Z652
BLUE CROSS BLUE SHIELD
NY
01
—
4313878
AETNA
NY
01
—
AS708
OXFORD
NY
01
—
JC042Z6520
GENERIC
NY
Enumeration date
11/10/2005
Last updated
07/08/2007
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