Provider Demographics
NPI:1033328281
Name:COOPERMAN, STUART ROY
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:ROY
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21221A 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2850
Mailing Address - Country:US
Mailing Address - Phone:718-229-0322
Mailing Address - Fax:718-426-5466
Practice Address - Street 1:21221A 73RD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2850
Practice Address - Country:US
Practice Address - Phone:718-229-0322
Practice Address - Fax:718-426-5466
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice