Provider Demographics
NPI:1952302754
Name:COOPER, JAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6300 8TH AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4718
Mailing Address - Country:US
Mailing Address - Phone:718-765-2744
Mailing Address - Fax:718-765-2754
Practice Address - Street 1:6300 8TH AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4718
Practice Address - Country:US
Practice Address - Phone:718-765-2744
Practice Address - Fax:718-765-2754
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY120799-12085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11002Medicare UPIN