Healthcare Provider Details

I. General information

NPI: 1144268277
Provider Name (Legal Business Name): COOPER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 200
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

1 FEDERAL STREET SW-200
CAMDEN NJ
08103-1155
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2001
  • Fax: 856-968-8206
Mailing address:
  • Phone: 856-356-4924
  • Fax: 856-382-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3401901
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: ANTHONY J. MAZZARELLI
Title or Position: CHIEF MEDICAL OFFICE
Credential: M.D.
Phone: 856-968-7858