Provider Demographics
NPI:1508229790
Name:COOPER FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:COOPER FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-968-7858
Mailing Address - Street 1:1 FEDERAL STREET
Mailing Address - Street 2:SUITE SW200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4920
Mailing Address - Fax:856-382-6455
Practice Address - Street 1:200 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3228
Practice Address - Country:US
Practice Address - Phone:856-536-1630
Practice Address - Fax:856-536-1635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER FAMILY MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty