Provider Demographics
NPI:1104806363
Name:COOPERSTONE, LESTER M (MD)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:M
Last Name:COOPERSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:972 BRUSH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1740
Mailing Address - Country:US
Mailing Address - Phone:516-876-5555
Mailing Address - Fax:516-876-1246
Practice Address - Street 1:221 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4515
Practice Address - Country:US
Practice Address - Phone:516-496-6548
Practice Address - Fax:516-496-2771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY168977208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01034775Medicaid
NYA60232Medicare UPIN
NY01034775Medicaid