Provider Demographics
NPI:1528038130
Name:COOPER, JOHN H (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:COOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8347
Mailing Address - Country:US
Mailing Address - Phone:609-926-5000
Mailing Address - Fax:609-926-2020
Practice Address - Street 1:301 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8347
Practice Address - Country:US
Practice Address - Phone:609-926-5000
Practice Address - Fax:609-926-2020
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB07722600208600000X, 2086S0129X
NJ25MB077226002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0078395Medicaid
NJ0078395Medicaid
NJI35934Medicare UPIN