Provider Demographics
NPI:1366559817
Name:COOPER, JEROME A (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:A
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 1:150 LOCKWOOD AVE
Mailing Address - Street 2:SUITE #28
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804
Mailing Address - Country:US
Mailing Address - Phone:914-633-7870
Mailing Address - Fax:914-633-7626
Practice Address - Street 1:150 LOCKWOOD AVE
Practice Address - Street 2:SUITE #28
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804
Practice Address - Country:US
Practice Address - Phone:914-633-7870
Practice Address - Fax:914-633-7626
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090394207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
4123681OtherAETNA PPO
538167OtherAETNA HMO
W5339OtherOXFORD
000873OtherPHS
01227178OtherUNITED
210550OtherGHI
NY00142847Medicaid
23518POtherHIP
8897196009OtherCIGNA
01227178OtherUNITED
W5339OtherOXFORD