Healthcare Provider Details

I. General information

NPI: 1568539252
Provider Name (Legal Business Name): MARSHALL COOPER D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592B SPRINGFIELD AVE SUITE A
WESTFIELD NJ
07090-1026
US

IV. Provider business mailing address

592B SPRINGFIELD AVE SUITE A
WESTFIELD NJ
07090-1026
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-1060
  • Fax: 908-233-4909
Mailing address:
  • Phone: 908-232-1060
  • Fax: 908-233-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00112300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: