Provider Demographics
NPI:1528183555
Name:COOPER, JOANN ALLEN (RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:ALLEN
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 OLD GALE HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12060-1802
Mailing Address - Country:US
Mailing Address - Phone:518-766-6307
Mailing Address - Fax:
Practice Address - Street 1:1 ABELE DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2951
Practice Address - Country:US
Practice Address - Phone:518-371-1400
Practice Address - Fax:518-371-1240
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005245-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY831685OtherREGISTRATION NUMBER