Healthcare Provider Details

I. General information

NPI: 1699778746
Provider Name (Legal Business Name): LESLIE B COOPERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NORTHERN BLVD STE 110
GREAT NECK NY
11021-5306
US

IV. Provider business mailing address

1010 NORTHERN BLVD STE 110
GREAT NECK NY
11021-5306
US

V. Phone/Fax

Practice location:
  • Phone: 516-390-2420
  • Fax: 516-482-7955
Mailing address:
  • Phone: 516-390-2420
  • Fax: 516-482-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number107129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: