=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053654749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOPER UNIVERSITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2013
-----------------------------------------------------
Last Update Date | 04/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 COOPER PLZ
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08103-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-342-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 COOPER PLZ
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08103-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-342-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ENT
-----------------------------------------------------
Name | DR. NADIR AHMAD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 856-342-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 26NJ00421800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------