Provider Demographics
NPI:1932155702
Name:COOPERMAN, HARRY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:ALAN
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 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:STE 1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-677-9729
Mailing Address - Fax:609-652-7153
Practice Address - Street 1:44 E JIMMIE LEEDS RD
Practice Address - Street 2:STE 101
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9599
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:609-652-6270
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA041119002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00847758OtherRAILROAD MEDICARE
NJP00793699OtherRAILROAD MEDICARE
NJ5133106Medicaid
NJP00658336OtherRAILROAD MEDICARE
NJP00847758OtherRAILROAD MEDICARE
E53089Medicare UPIN
NJ5133106Medicaid
NJ083965AMLMedicare PIN