Provider Demographics
NPI:1487647608
Name:COOPERMAN, MITCHELL ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ALLEN
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6912
Mailing Address - Country:US
Mailing Address - Phone:516-931-3613
Mailing Address - Fax:516-931-3320
Practice Address - Street 1:346 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6912
Practice Address - Country:US
Practice Address - Phone:516-931-3613
Practice Address - Fax:516-931-3320
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN2841213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP31161Medicare ID - Type Unspecified
NY5134850001Medicare NSC
T50880Medicare UPIN