Provider Demographics
NPI:1104041722
Name:COOPERSTEIN, HEIDI BETH (DO)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:BETH
Last Name:COOPERSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:128 BORTONS LANDING RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3011
Mailing Address - Country:US
Mailing Address - Phone:856-231-0690
Mailing Address - Fax:856-231-1228
Practice Address - Street 1:128 BORTONS LANDING RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3011
Practice Address - Country:US
Practice Address - Phone:856-231-0690
Practice Address - Fax:856-231-1228
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB-597092084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ729606Medicaid
NJG51596Medicare UPIN
NJ729606Medicaid