Basic Information
| Provider Information | |||||||||
| NPI: | 1396771283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAKLA | ||||||||
| FirstName: | MADGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST STE SW200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | 8563564710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COOPER PLZ | ||||||||
| Address2: | COOPER ANESTHESIA ASSOCIATES | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563422425 | ||||||||
| FaxNumber: | 8569688326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 04/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 25MA06264500 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 25MA06264500 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 8783501 | 05 | NJ | MEDICAID | 010007776 | 01 | NJ | AMERICHOICE | OTHER | 1121097 | 01 | NJ | AETNA | OTHER | 2075003000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC/PABS | OTHER | P3722605 | 01 | NJ | OXFORD | OTHER | 1121106 | 01 | NJ | AETNA | OTHER | 2735366 | 01 | NJ | CIGNA | OTHER | 2816920 | 01 | NJ | UNITED HEATHCARE | OTHER | 1384269 | 01 | NJ | AMERIHEALTH PPO/PA BS | OTHER | 60022562 | 01 | NJ | HORIZON NJ HEALTH | OTHER |