Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 2147081 | NY |
N | 2081P2900X | Pain Medicine | 25MA06476700 | NJ |
NPI | 1114952892 |
---|---|
Provider Name | Paul Matthew Cooke |
First Address | New York, NY 10087-9234 |
Second Address | New York, NY 10021-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H09957 | (02) |