Provider Demographics
NPI:1225481385
Name:THE COOPER HEALTH SYSTEM
Entity Type:Organization
Organization Name:THE COOPER HEALTH SYSTEM
Other - Org Name:COOPER UNIVERSITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR EXECUTIVE VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-342-2443
Mailing Address - Street 1:1 COOPER PLZ
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:856-342-2000
Mailing Address - Fax:856-382-6547
Practice Address - Street 1:97 BOGDEN BLVD
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-4814
Practice Address - Country:US
Practice Address - Phone:856-765-5584
Practice Address - Fax:856-765-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1017633416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4136004Medicaid
31-0014Medicare PIN