Basic Information
| Provider Information | |||||||||
| NPI: | 1154369510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COOPER PHYSICIAN OFFICES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL STREET | ||||||||
| Address2: | SW-200 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | 8563826455 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 COOPER PLZ | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563422439 | ||||||||
| FaxNumber: | 8569660735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | MAZZARELLI | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 8569687858 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0736144001 | 01 | AMERIHEALTH | OTHER | 0736144029 | 01 | AMERIHEALTH | OTHER | 3946789 | 01 | AETNA - 196 GROVE AVE, THOROFARE, NJ | OTHER | 475767 | 01 | AETNA - 900 CENTENNIAL BLVD., VOORHEES, NJ | OTHER | 0736144000 | 01 | AMERIHEALTH | OTHER | 0736144012 | 01 | AMERIHEALTH | OTHER | 1153819 | 01 | AETNA - 13 TOMLINSON ., MEDFORD, NJ | OTHER | 115506 | 01 | AETNA - 3 COOPER PLAZA, SUITE 215 CAMDEN, NJ | OTHER | 3626248 | 01 | AETNA - 1103 N. KINGS HWY, CHERRY HILL, NJ | OTHER | 6223605 | 05 | NJ | MEDICAID | 735993 | 01 | AETNA - 1210 BRACE RD., CHERRY HIL, NJ | OTHER | 0736144003 | 01 | AMERIHEALTH | OTHER | 482284 | 01 | AETNA - 1103 NORTH KINGS HWY, CHERRY HILL, NJ | OTHER | 0736144002 | 01 | AMERIHEALTH | OTHER | 0736144027 | 01 | AMERIHEALTH | OTHER | 0736144004 | 01 | AMERIHEALTH | OTHER | 0736144005 | 01 | AMERIHEALTH | OTHER | 0736144013 | 01 | AMERIHEALTH | OTHER | 0736144025 | 01 | AMERIHEALTH | OTHER | 0736144028 | 01 | AMERIHEALTH | OTHER | 288755 | 01 | AETNA | OTHER | 478779 | 01 | AETNA - 14 S BROADWAY ,GLOUCESTER, NJ | OTHER |