1508229790 NPI number — COOPER FAMILY MEDICINE PC

Table of content: (NPI 1508229790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508229790 NPI number — COOPER FAMILY MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOPER FAMILY MEDICINE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508229790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FEDERAL STREET
Provider Second Line Business Mailing Address:
SUITE SW200
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-356-4920
Provider Business Mailing Address Fax Number:
856-382-6455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 COLLEGE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-536-1630
Provider Business Practice Location Address Fax Number:
856-536-1635
Provider Enumeration Date:
04/04/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAZZARELLI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
856-968-7858

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)