Provider Demographics
NPI:1881096147
Name:COOPER PHYSICIAN OFFICES
Entity type:Organization
Organization Name:COOPER PHYSICIAN OFFICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
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:PO BOX 6019
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-6019
Mailing Address - Country:US
Mailing Address - Phone:856-356-4935
Mailing Address - Fax:856-356-4879
Practice Address - Street 1:6100 MAIN ST
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4643
Practice Address - Country:US
Practice Address - Phone:856-673-4912
Practice Address - Fax:856-673-4497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER PHYSICIAN OFFICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ535207Medicare PIN