NPIMap

Organization Active NPI

Cooper University Trauma Physicians, PC

  • Trauma Surgery Physician
  • Camden, NJ
National Provider Identifier
1790724730
Registry record updated Jul 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
Legal business name
COOPER UNIVERSITY TRAUMA PHYSICIANS, PC
Practice address
1 Cooper PLZ
Camden, NJ 08103-1461
Phone
(856) 342-3014
Fax
(856) 342-2817
NPI assigned
Jun 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2016

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

Authorized official

Name
Anthony J. Mazzarelli, M.D.
Title
Chief Medical Office
Phone
(856) 968-7858

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Trauma Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0127X
Trauma Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0127X NJ Primary

Addresses

Primary practice location

1 Cooper PLZ
Camden, NJ 08103-1461

Mailing address

1 Federal Street
SW-200
Camden, NJ 08103-1155
Phone (856) 356-4924

Other identifiers 3

IdentifierTypeStateIssuer
3308828OtherNJAETNA GRP NUMBER
2283236000OtherNJAMERIHEALTH/KEYSTONE/IBC
0060542MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422000430 NJ Part B Supplier - Clinic/Group Practice 3678569951 Receives reassigned benefits from 109 practitioners
Practice locations: Camden, NJ; Voorhees, NJ; Moorestown, NJ; Cape May Court House, NJ

National Provider Directory

National Provider Directory

Locations

1 Cooper Plz
Ste C203
Camden, NJ 08103

Practitioners & affiliated clinicians

Practitioners 110

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 110

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469577600000",
    "number": "1790724730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FEDERAL STREET",
            "address_2": "SW-200",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031155",
            "telephone_number": "856-356-4924",
            "fax_number": "856-382-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COOPER PLZ",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031461",
            "telephone_number": "856-342-3014",
            "fax_number": "856-342-2817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPER UNIVERSITY TRAUMA PHYSICIANS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2016-07-27",
        "status": "A",
        "authorized_official_last_name": "MAZZARELLI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICE",
        "authorized_official_telephone_number": "856-968-7858",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GRP NUMBER",
            "identifier": "3308828",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH/KEYSTONE/IBC",
            "identifier": "2283236000",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060542",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.