Basic Information
| Provider Information | |||||||||
| NPI: | 1194793836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNTAZAR | ||||||||
| FirstName: | MUHAMMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 COOPER PLZ | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569636888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 COOPER PLZ | ||||||||
| Address2: | COOPER ANESTHESIA ASSOCIATES | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569687334 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 09/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 21343 | OK | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0108162 | 05 | NJ | MEDICAID | 1314502 | 01 | NJ | AETNA | OTHER | 2742379000 | 01 | NJ | AMERIHEALTH | OTHER | 4936196 | 01 | NJ | CIGNA | OTHER | 100821910B | 05 | OK | MEDICAID | 60028042 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 01077778000 | 01 | NJ | AMERICHOICE | OTHER | 1314503 | 01 | NJ | AETNA | OTHER | 2082246 | 01 | NJ | UNITED HEALTHCARE | OTHER | 60028040 | 01 | NJ | HORIZON NJ HEALTH | OTHER |