Provider Demographics
NPI:1881859080
Name:COOPER, NITI D (DO)
Entity Type:Individual
Prefix:
First Name:NITI
Middle Name:D
Last Name:COOPER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NITI
Other - Middle Name:
Other - Last Name:DALAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:352 S DELSEA DR STE C
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5306
Mailing Address - Country:US
Mailing Address - Phone:856-690-1616
Mailing Address - Fax:856-896-6107
Practice Address - Street 1:352 S DELSEA DR STE C
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5306
Practice Address - Country:US
Practice Address - Phone:856-690-1616
Practice Address - Fax:856-896-6107
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB08187500207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1886108OtherAETNA
NJ3530925000OtherAMERIHEALTH/KEYSTONE/PABS
NJ0171646Medicaid
NJ60042790OtherHORIZON NJ HEALTH
NJ01004660800OtherAMERICHOICE
NJ60042789OtherHORIZON NJ HEALTH
132170 DLFMedicare PIN
NJ3530925000OtherAMERIHEALTH/KEYSTONE/PABS