Provider Demographics
NPI:1659377349
Name:NEMIROFF, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:NEMIROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST
Mailing Address - Street 2:STE SW200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:ONE COOPER PLAZA
Practice Address - Street 2:COOPER ANESTHESIA ASSOCIATES
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-342-2425
Practice Address - Fax:856-968-8239
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-036712-L207L00000X
NJMA03319600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0083506000OtherAMERIHEALTH/KEYSTONE/IBC
NJ010046593OtherAMERIHCOICE
NJ2423652OtherUNITED HEALTHCARE
NJ2048400Medicaid
NJ1867334/4201149OtherAETNA
NJ60040928OtherHORIZON NJ HEALTH
NJ60040929OtherHORIZON NJ HEALTH
PA00781956Medicaid
NJ6184259OtherCIGNA
C57245Medicare UPIN
NJ010046593OtherAMERIHCOICE
NJ1867334/4201149OtherAETNA
NJ2048400Medicaid