# COOPER SURGICAL ASSCOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COOPER SURGICAL ASSCOCIATES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1649463696
- **Legal business name:** COOPER SURGICAL ASSCOCIATES
- **Authorized official:** ROBERT MCMULLEN (EVP - MANAGED CARE)
- **Authorized official phone:** (856) 968-7263

## Contact information

- **Practice address:** 3 COOPER PLZ, SUITE 411, CAMDEN, NJ 08103-1438
- **Practice address phone:** (856) 342-3250
- **Mailing address:** 3 COOPER PLZ, SUTIE 502, CAMDEN, NJ 08103-1438
- **Mailing address phone:** (856) 968-7433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/23/2007
- **Last updated:** 08/23/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2843948000 | AMERIHEALTH/KEYSTONE/IBC | NJ |
| 05 | — | 2865807 | — | NJ |