Healthcare Provider Details

I. General information

NPI: 1699061903
Provider Name (Legal Business Name): COOPER SURGICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PLAZA DR BUILDING 2, SUITE 203
SEWELL NJ
08080-9207
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-270-4100
  • Fax: 856-270-4012
Mailing address:
  • Phone: 856-963-6888
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN E BEKES
Title or Position: CHIEF MEDICAL OFFICER, SEVP
Credential: MD
Phone: 856-963-6888