Provider Demographics
NPI:1568539252
Name:COOPER, MARSHALL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:COOPER
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 1:592B SPRINGFIELD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1026
Mailing Address - Country:US
Mailing Address - Phone:908-232-1060
Mailing Address - Fax:908-233-4909
Practice Address - Street 1:592B SPRINGFIELD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1026
Practice Address - Country:US
Practice Address - Phone:908-232-1060
Practice Address - Fax:908-233-4909
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00112300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0513407Medicaid
4723350001OtherDMERC
1100880001OtherDMERC
NJ422944Medicare PIN
1100880001OtherDMERC
4723350001OtherDMERC