Provider Demographics
NPI:1710705918
Name:COOPERMAN, ASSEL (LAC)
Entity type:Individual
Prefix:
First Name:ASSEL
Middle Name:
Last Name:COOPERMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 82ND ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2739
Mailing Address - Country:US
Mailing Address - Phone:917-930-8388
Mailing Address - Fax:
Practice Address - Street 1:4 W 43RD ST STE 620
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7416
Practice Address - Country:US
Practice Address - Phone:646-617-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist