Provider Demographics
NPI:1275682783
Name:COOPERMAN, BRUCE WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WILLIAM
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 PLAZA DR
Mailing Address - Street 2:STE 11
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3765
Mailing Address - Country:US
Mailing Address - Phone:732-349-3400
Mailing Address - Fax:732-349-3403
Practice Address - Street 1:3 PLAZA DR
Practice Address - Street 2:STE 11
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3765
Practice Address - Country:US
Practice Address - Phone:732-349-3400
Practice Address - Fax:732-349-3403
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00259600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19005Medicare UPIN
NJ043121Medicare ID - Type Unspecified