Provider Demographics
NPI:1558329953
Name:COOPER, SCOTT (M D)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 E 89TH ST
Mailing Address - Street 2:APT. 1W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4502
Mailing Address - Country:US
Mailing Address - Phone:212-289-6857
Mailing Address - Fax:
Practice Address - Street 1:2016 BRONXDALE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3388
Practice Address - Country:US
Practice Address - Phone:718-409-2222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127283207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00669723Medicaid
B78067Medicare UPIN
58A191Medicare ID - Type Unspecified