Provider Demographics
NPI:1205242955
Name:COOPER, ILEANA (CNM)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:COOPER
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CLINTON PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2102
Mailing Address - Country:US
Mailing Address - Phone:347-967-7364
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2237
Practice Address - Country:US
Practice Address - Phone:913-264-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00090201367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife