NPIMap

Organization Active NPI

Footprint New Jersey Limited Liability Company

  • Clinical Psychologist
  • Jersey City, NJ
National Provider Identifier
1669862199
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35SI00482700 Issued in NJ
Legal business name
FOOTPRINT NEW JERSEY LIMITED LIABILITY COMPANY
Practice address
121 Newark Ave
Ste. 503
Jersey City, NJ 07302-5872
Phone
(201) 240-6186
Fax
(201) 763-6606
NPI assigned
Feb 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Sarosh M Cooper, PH.D.
Title
Psychologist
Phone
(201) 240-6186

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 35SI00482700 NJ Primary

Addresses

Primary practice location

121 Newark Ave
Ste. 503
Jersey City, NJ 07302-5872

Mailing address

121 Newark Ave
Ste. 503
Jersey City, NJ 07302-5872
Phone (201) 240-6186

National Provider Directory

National Provider Directory

Locations

121 Newark Ave
Ste 410
Jersey City, NJ 07302
Phone (201) 240-6186

121 Newark Ave
Ste 503
Jersey City, NJ 07302
Phone (201) 240-1437

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1669862199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 NEWARK AVE",
            "address_2": "STE. 503",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073025872",
            "telephone_number": "201-240-6186",
            "fax_number": "201-763-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 NEWARK AVE",
            "address_2": "STE. 503",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073025872",
            "telephone_number": "201-240-6186",
            "fax_number": "201-763-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTPRINT NEW JERSEY LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-05",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "SAROSH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "201-240-6186",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00482700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.