Healthcare Provider Details

I. General information

NPI: 1487583993
Provider Name (Legal Business Name): SCOTT PETER COOPER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 W CLINTON AVE APT 1O
TENAFLY NJ
07670-2077
US

IV. Provider business mailing address

27 W CLINTON AVE APT 1O
TENAFLY NJ
07670-2077
US

V. Phone/Fax

Practice location:
  • Phone: 201-390-6752
  • Fax:
Mailing address:
  • Phone: 201-390-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26NO10423300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: