Provider Demographics
NPI:1114668084
Name:COOPER SCIASCIA DC LLC
Entity Type:Organization
Organization Name:COOPER SCIASCIA DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COOPER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCIASCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-577-7185
Mailing Address - Street 1:1313 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4338
Mailing Address - Country:US
Mailing Address - Phone:718-448-0687
Mailing Address - Fax:718-448-3463
Practice Address - Street 1:1313 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4338
Practice Address - Country:US
Practice Address - Phone:718-448-0687
Practice Address - Fax:718-448-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty