Provider Demographics
NPI:1588692974
Name:COOPER, SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5028
Mailing Address - Country:US
Mailing Address - Phone:347-702-7324
Mailing Address - Fax:
Practice Address - Street 1:30 DEKALB AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5314
Practice Address - Country:US
Practice Address - Phone:718-744-7209
Practice Address - Fax:718-488-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00287600213E00000X
NYN006205213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02948612Medicaid
NY02948612Medicaid