Provider Demographics
NPI:1902176670
Name:COOPER AUDIOLOGY LLC
Entity Type:Organization
Organization Name:COOPER AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:SCD, CCC-A, FAAA
Authorized Official - Phone:908-461-7085
Mailing Address - Street 1:509 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4632
Mailing Address - Country:US
Mailing Address - Phone:908-461-7085
Mailing Address - Fax:732-817-1800
Practice Address - Street 1:509 APACHE TRL
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4632
Practice Address - Country:US
Practice Address - Phone:908-461-7085
Practice Address - Fax:732-817-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00081200261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ277231OtherMEDICARE PTAN