Provider Demographics
NPI:1477923613
Name:COOPER KIDS THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:COOPER KIDS THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-496-4460
Mailing Address - Street 1:2 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3064
Mailing Address - Country:US
Mailing Address - Phone:516-496-4460
Mailing Address - Fax:
Practice Address - Street 1:2 ROOSEVELT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3064
Practice Address - Country:US
Practice Address - Phone:516-496-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization