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Organization
COOPER SURGICAL ASSOCIATES, PA
Active
Organization
COOPER SURGICAL ASSOCIATES, PA
Active
Other names
Cooper Oral Max
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MCMULLEN (EVP MANAGED CARE ADMINASTRATION)
(856) 342-7369
Entity
Organization
Contact information
Practice address
2 PLAZA DR, SUITE 202, BUNKER HILL PLAZA, SEWELL, NJ 08080-9207
(856) 270-4100
Mailing address
3 COOPER PLZ, SUITE 502, CAMDEN, NJ 08103-1438
(856) 968-7433
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082057000
AMERIHEALTH GRP NUMBER
NJ
05
—
2865815
—
NJ
Enumeration date
03/27/2007
Last updated
06/26/2008
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