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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