Provider Demographics
NPI:1114108073
Name:DAVID COOPER MD PC
Entity Type:Organization
Organization Name:DAVID COOPER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-365-2300
Mailing Address - Street 1:3111 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1217
Mailing Address - Country:US
Mailing Address - Phone:516-365-2300
Mailing Address - Fax:516-365-2165
Practice Address - Street 1:3111 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1217
Practice Address - Country:US
Practice Address - Phone:516-365-2300
Practice Address - Fax:516-365-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1871713156OtherNPI
NY5F0711Medicare PIN
NY34H181Medicare PIN
NY3K7291Medicare PIN
NYWZT4Y1Medicare UPIN