Healthcare Provider Details

I. General information

NPI: 1558032474
Provider Name (Legal Business Name): ROBERT A COOPER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ST
UTICA NY
13502-4245
US

IV. Provider business mailing address

111 HOSPITAL DR ATTN:CREDENTIALING
UTICA NY
13502-2517
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-4090
  • Fax: 315-624-4095
Mailing address:
  • Phone: 315-624-6100
  • Fax: 315-624-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: