Provider Demographics
NPI:1891883310
Name:COOPERMAN, JOEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:COOPERMAN
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 1:21 VALE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6160
Mailing Address - Country:US
Mailing Address - Phone:973-839-0273
Mailing Address - Fax:973-839-5044
Practice Address - Street 1:19-04 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2341
Practice Address - Country:US
Practice Address - Phone:201-794-3132
Practice Address - Fax:201-794-6291
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA281922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0869805Medicaid
NJ0869805Medicaid
NJ551591BSQMedicare ID - Type Unspecified