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: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MARCUS AVE
LAKE SUCCESS NY
11042-1008
US

IV. Provider business mailing address

2800 MARCUS AVE
LAKE SUCCESS NY
11042-1008
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-6100
  • Fax: 516-622-6111
Mailing address:
  • Phone: 516-622-6100
  • Fax: 516-622-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number181794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: