1396771283 NPI number — MADGY TAKLA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396771283 NPI number — MADGY TAKLA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TAKLA

Provider First Name:

MADGY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

M

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:

1396771283

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/16/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 FEDERAL ST STE SW200

Provider Second Line Business Mailing Address:

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:

856-356-4924

Provider Business Mailing Address Fax Number:

856-356-4710

Provider First Line Business Practice Location Address:

1 COOPER PLZ

Provider Second Line Business Practice Location Address:

COOPER ANESTHESIA ASSOCIATES

Provider Business Practice Location Address City Name:

CAMDEN

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08103-1461

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-342-2425

Provider Business Practice Location Address Fax Number:

856-968-8326

Provider Enumeration Date:

06/23/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207LP2900X , with the licence number:  25MA06264500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207L00000X , with the licence number: 25MA06264500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 8783501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 010007776 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1121097 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2075003000 . This is a "AMERIHEALTH/KEYSTONE/IBC/PABS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P3722605 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1121106 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2735366 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2816920 . This is a "UNITED HEATHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1384269 . This is a "AMERIHEALTH PPO/PA BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 60022562 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".