Provider Demographics
NPI:1962703819
Name:COOPER UNIVERSITY HOSPITAL CHILDREN'S REGIONAL HOSPITAL
Entity type:Organization
Organization Name:COOPER UNIVERSITY HOSPITAL CHILDREN'S REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAESSLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-757-7904
Mailing Address - Street 1:401 HADDON AVE
Mailing Address - Street 2:E & R BUILDING 3RD FLOOR
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 HADDON AVE
Practice Address - Street 2:E & R BUILDING 3RD FLOOR
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1505
Practice Address - Country:US
Practice Address - Phone:856-757-7904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren