1124087572 NPI number — MRS. ANNE MARIE COOK RPAC

Table of content: MRS. ANNE MARIE COOK RPAC (NPI 1124087572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124087572 NPI number — MRS. ANNE MARIE COOK RPAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
ANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAUSGRUBER
Provider Other First Name:
ANNE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124087572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
346 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13790-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-729-8156
Provider Business Mailing Address Fax Number:
607-729-2209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 MITCHELL AVE
Provider Second Line Business Practice Location Address:
SUITE G50
Provider Business Practice Location Address City Name:
BINGHAMTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13903-1674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-771-2220
Provider Business Practice Location Address Fax Number:
607-771-2225
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  MA051704 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 009125-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02368078 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: GU039978 . This is a "MEDICARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00147128 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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