Healthcare Provider Details

I. General information

NPI: 1093187163
Provider Name (Legal Business Name): COOPER UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 301
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 221
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2959
  • Fax:
Mailing address:
  • Phone: 856-342-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB09779200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number25MB09779200
License Number StateNJ

VIII. Authorized Official

Name: DR. PAULA A BRUCKLER
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 856-342-2959