Provider Demographics
NPI:1700868015
Name:COOPER, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N CENTRE AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3923
Mailing Address - Country:US
Mailing Address - Phone:516-766-3730
Mailing Address - Fax:516-678-3620
Practice Address - Street 1:77 N CENTRE AVE
Practice Address - Street 2:STE 306
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3923
Practice Address - Country:US
Practice Address - Phone:516-766-3730
Practice Address - Fax:516-678-3620
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1271062086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D46779Medicare UPIN