Basic Information
| Provider Information | |||||||||
| NPI: | 1659377349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEMIROFF | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST | ||||||||
| Address2: | STE SW200 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569687433 | ||||||||
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| Practice Location | |||||||||
| Address1: | ONE COOPER PLAZA | ||||||||
| Address2: | COOPER ANESTHESIA ASSOCIATES | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563422425 | ||||||||
| FaxNumber: | 8569688239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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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 | 207L00000X | MD-036712-L | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MA03319600 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0083506000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 010046593 | 01 | NJ | AMERIHCOICE | OTHER | 2423652 | 01 | NJ | UNITED HEALTHCARE | OTHER | 2048400 | 05 | NJ | MEDICAID | 1867334/4201149 | 01 | NJ | AETNA | OTHER | 60040928 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 60040929 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 00781956 | 05 | PA | MEDICAID | 6184259 | 01 | NJ | CIGNA | OTHER |