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General NPI Number Information
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NPI Number | 1578825881
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Entity Type | Individual
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Provider Name | MRS. LISA M COOPER
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 4400 VESTAL PARKWAY EAST BINGHAMTON UNIVERSITY
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City | VESTAL
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State | NY
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Zip | 13902
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Country | US
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Telephone | 607-777-2829
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Fax |
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Provider Business Mailing Address
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Address Line | 133 DAVID AVE
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City | VESTAL
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State | NY
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Zip | 13850-3346
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Country | US
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Telephone | 607-768-1477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 634608051
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License Number State | NY
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