Provider Demographics
NPI:1003009051
Name:COOPER SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:COOPER SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP - MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-968-7263
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:4 PLAZA DR
Practice Address - Street 2:SUITE 402
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2747
Practice Address - Country:US
Practice Address - Phone:856-270-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER SURGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2846863000OtherAMERIHEALTH/KEYSTONE/IBC
NJ3285316Medicaid
NJ900276Medicare Oscar/Certification