Provider Demographics
NPI:1083747323
Name:COOPER NEPHROLOGY, PC
Entity Type:Organization
Organization Name:COOPER NEPHROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEVP
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAZZARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-968-7433
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:856-342-2921
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:UNIVERSITY RENAL ASSOCIATES, SUITE 215
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-757-7844
Practice Address - Fax:856-757-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2233338000OtherNEPHROLOGY GRP#
NJ049041 PW2Medicare PIN