Provider Demographics
NPI:1649217175
Name:COOPER FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:COOPER FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICE
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:856-968-7858
Mailing Address - Street 1:1 FEDERAL STREET
Mailing Address - Street 2:SW-200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:856-382-6455
Practice Address - Street 1:1050 KINGS HWY N
Practice Address - Street 2:SUITE 105
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1909
Practice Address - Country:US
Practice Address - Phone:856-321-0303
Practice Address - Fax:856-321-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NJ207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6558101Medicaid
812711OtherAETNA
957013OtherAETNA
0341834001OtherAMERIHEALTH
10825OtherAETNA
0538689001OtherAMERIHEALTH
0790979001OtherAMERIHEALTH
10678OtherAETNA
0807068001OtherAMERIHEALTH
0125591001OtherAMERIHEALTH
0807062001OtherAMERIHEALTH
10665OtherAETNA
2218882006OtherAMERIHEALTH
497006OtherAETNA
511584OtherAETNA
0807066001OtherAMERIHEALTH
10453OtherAETNA
0538689001OtherAMERIHEALTH
NJDB3232Medicare PIN
NJ5037022457Medicare PIN
NJ838628 DK6Medicare PIN
NJ774784 DDMMedicare PIN
10678OtherAETNA
497006OtherAETNA
NJCK7954Medicare PIN
NJ780305 DD2Medicare PIN
NJCA7434Medicare PIN
0807062001OtherAMERIHEALTH
0807066001OtherAMERIHEALTH
812711OtherAETNA
NJCG5476Medicare PIN
957013OtherAETNA
10453OtherAETNA
10825OtherAETNA
2218882006OtherAMERIHEALTH
NJ780306 DD3Medicare PIN