Individual
NITI D COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
352 S DELSEA DR STE C, VINELAND, NJ 08360-5306
(856) 690-1616
(856) 896-6107
Mailing address
352 S DELSEA DR STE C, VINELAND, NJ 08360-5306
(856) 690-1616
(856) 896-6107
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MB08187500
NJ
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MB08187500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01004660800
AMERICHOICE
NJ
05
—
0171646
—
NJ
01
—
1886108
AETNA
NJ
01
—
3530925000
AMERIHEALTH/KEYSTONE/PABS
NJ
01
—
60042789
HORIZON NJ HEALTH
NJ
01
—
60042790
HORIZON NJ HEALTH
NJ
Enumeration date
07/28/2008
Last updated
08/06/2021
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