{
"Npi": {
"NPI": "1912354580",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COOPER FAMILY MEDICINE PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1 FEDERAL ST",
"SecondLineMailingAddress": "SUITE SW200",
"MailingAddressCityName": "CAMDEN",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08103-1088",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-356-4920",
"MailingAddressFaxNumber": "856-382-6455",
"FirstLinePracticeLocationAddress": "3 COOPER PLZ",
"SecondLinePracticeLocationAddress": "104",
"PracticeLocationAddressCityName": "CAMDEN",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08103-1438",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "856-342-2445",
"PracticeLocationAddressFaxNumber": "856-964-0504",
"EnumerationDate": "05/24/2016",
"LastUpdateDate": "05/24/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAZZARELLI",
"AuthorizedOfficialFirstName": "ANTHONY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CMO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "856-968-7858",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}