Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA06625000 | NJ |
NPI | 1053378935 |
---|---|
Provider Name | Dr. Todd J. Cooperman |
First Address | Marlboro, NJ 07746 |
Second Address | Freehold, NJ 07728-2963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0068209 | (05) | NJ |
G53173 | (02) |