Healthcare Provider Details

I. General information

NPI: 1053375220
Provider Name (Legal Business Name): STANLEY COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WESTCHESTER AVE RM 102
BRONX NY
10461-4548
US

IV. Provider business mailing address

200 N WARNER RD STE 205
KING OF PRUSSIA PA
19406-2841
US

V. Phone/Fax

Practice location:
  • Phone: 718-794-9729
  • Fax: 718-794-9730
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number181794
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA07577100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: