Provider Demographics
NPI:1396022745
Name:COOPER, DAVID (SCD, CCC-A, FAAA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:SCD, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4632
Mailing Address - Country:US
Mailing Address - Phone:908-461-7085
Mailing Address - Fax:
Practice Address - Street 1:509 APACHE TRL
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4632
Practice Address - Country:US
Practice Address - Phone:908-461-7085
Practice Address - Fax:732-817-1834
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00081200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MG00126300OtherHEARING AID DISPENSER
NJ41YA00081200OtherAUDIOLOGY LICENSE