Healthcare Provider Details

I. General information

NPI: 1912354580
Provider Name (Legal Business Name): COOPER FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ 104
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

1 FEDERAL ST SUITE SW200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2445
  • Fax: 856-964-0504
Mailing address:
  • Phone: 856-356-4920
  • Fax: 856-382-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: ANTHONY MAZZARELLI
Title or Position: CMO
Credential: M.D.
Phone: 856-968-7858