Provider Demographics
NPI:1144464165
Name:COOPERMAN, JEFFREY
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:COOPERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N GANNON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4343
Mailing Address - Country:US
Mailing Address - Phone:917-414-4552
Mailing Address - Fax:718-982-8931
Practice Address - Street 1:117 N GANNON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4343
Practice Address - Country:US
Practice Address - Phone:917-414-4552
Practice Address - Fax:718-982-8931
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist