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General NPI Number Information
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NPI Number | 1831110105
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Entity Type | Organization
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Legal Business Name | COOPER GYN ONCOLOGY ASSOCIATION, PC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 3 COOPER PLZ SUITE 104
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City | CAMDEN
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State | NJ
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Zip | 08103-1438
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Country | US
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Telephone | 856-342-2186
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Fax | 856-365-1967
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Provider Business Mailing Address
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Address Line | 1 FEDERAL STREET SW-200
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City | CAMDEN
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State | NJ
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Zip | 08103-1155
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Country | US
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Telephone | 856-356-4924
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Fax | 856-382-6455
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICE
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Name | ANTHONY J. MAZZARELLI
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Credential | M.D.
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Telephone | 856-968-7858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State | NJ
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