Provider Demographics
NPI:1275629347
Name:COOPER, STEVEN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
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 1:55 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2826
Mailing Address - Country:US
Mailing Address - Phone:845-425-4713
Mailing Address - Fax:845-425-4713
Practice Address - Street 1:55 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2826
Practice Address - Country:US
Practice Address - Phone:845-425-4713
Practice Address - Fax:845-425-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1657742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
01F44FW271OtherMEDICARE PTAN
NY06000165774Medicaid
01F44FW271OtherMEDICARE PTAN