Provider Demographics
NPI:1386859684
Name:COOPERMAN, AVRAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:AVRAM
Middle Name:M
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-0207
Mailing Address - Country:US
Mailing Address - Phone:212-995-6611
Mailing Address - Fax:212-995-6614
Practice Address - Street 1:227 E 19TH ST
Practice Address - Street 2:D231
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2602
Practice Address - Country:US
Practice Address - Phone:212-995-6611
Practice Address - Fax:212-995-6614
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138892207R00000X, 208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB09986Medicare UPIN
NY17A891Medicare PIN