NPIMap

Organization Active NPI

Cooper Pediatric Specialist

  • Pediatric Gastroenterology Physician
  • Sewell, NJ
National Provider Identifier
1740301605
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
Legal business name
COOPER PEDIATRIC SPECIALIST
Practice address
4 Plaza Dr Ste 401
Bunker Hill Plaza
Sewell, NJ 08080-2747
Phone
(856) 270-4050
NPI assigned
Apr 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert McMullen
Title
Evp Managed Care
Phone
(856) 342-7369

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X NU Primary

Addresses

Primary practice location

4 Plaza Dr Ste 401
Bunker Hill Plaza
Sewell, NJ 08080-2747

Mailing address

3 Cooper PLZ
Suite 502
Camden, NJ 08103-1438
Phone (856) 968-7433

Other identifiers 1

IdentifierTypeStateIssuer
9024603MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Cooper Pediatric Specialists15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740301605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 COOPER PLZ",
            "address_2": "SUITE 502",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031438",
            "telephone_number": "856-968-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 PLAZA DR STE 401",
            "address_2": "BUNKER HILL PLAZA",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802747",
            "telephone_number": "856-270-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPER PEDIATRIC SPECIALIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCMULLEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EVP MANAGED CARE",
        "authorized_official_telephone_number": "856-342-7369"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9024603",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewell, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.