Healthcare Provider Details

I. General information

NPI: 1487647608
Provider Name (Legal Business Name): MITCHELL ALLEN COOPERMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 S OYSTER BAY RD
SYOSSET NY
11791-6912
US

IV. Provider business mailing address

346 S OYSTER BAY RD
SYOSSET NY
11791-6912
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-3613
  • Fax: 516-931-3320
Mailing address:
  • Phone: 516-931-3613
  • Fax: 516-931-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN2841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: