Provider Demographics
NPI:1033295001
Name:COOPER, CORNELIUS MCNEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:MCNEAL
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CENTRAL PARK W
Mailing Address - Street 2:APT. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4378
Mailing Address - Country:US
Mailing Address - Phone:212-932-2560
Mailing Address - Fax:
Practice Address - Street 1:4802 TENTH AVE
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE, MAIMONIDES MEDICAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-604-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127530207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00669376Medicare PIN
NYA400005015Medicare PIN