Provider Demographics
NPI:1417241688
Name:COOPER ANNICCHIARICO, MANDY SUZANNE
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:SUZANNE
Last Name:COOPER ANNICCHIARICO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MANDY
Other - Middle Name:SUZANNE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 KINGSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-7428
Mailing Address - Country:US
Mailing Address - Phone:908-255-4160
Mailing Address - Fax:
Practice Address - Street 1:14 KINGSWOOD RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-7428
Practice Address - Country:US
Practice Address - Phone:908-255-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist