Healthcare Provider Details

I. General information

NPI: 1568665594
Provider Name (Legal Business Name): COOPER FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N BROAD ST
WOODBURY NJ
08096-1619
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-845-7200
  • Fax: 856-845-9898
Mailing address:
  • Phone: 856-342-2921
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT MCMULLEN
Title or Position: EVP MANAGED CARE
Credential:
Phone: 856-342-2921