Healthcare Provider Details

I. General information

NPI: 1932193521
Provider Name (Legal Business Name): HARVEY COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HAMBURG TPKE STE G3
WAYNE NJ
07470-2110
US

IV. Provider business mailing address

220 HAMBURG TPKE STE G3
WAYNE NJ
07470-2110
US

V. Phone/Fax

Practice location:
  • Phone: 973-942-0040
  • Fax: 973-942-4741
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMAO18558
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: