MEDICARE: KEVIN NORMAN KOPACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	40QAO0335300	NJ

General Provider Information

NPI Number	:	1740577964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN NORMAN KOPACK

Provider Business Mailing Address
First Line	:	297 PASSAIC AVE STE 3
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-2548
Country	:	US
Telephone Number	:	973-227-4280
Fax Number	:	973-227-4210

Provider Business Practice Location Address
First Line	:	297 PASSAIC AVE
Second Line	:	UNIT 3
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-2503
Country	:	US
Telephone Number	:	973-227-4280
Fax Number	:	973-227-4210

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	MR. KEVIN NORMAN KOPACK
Credential	:	P.T.
Telephone Number	:	973-227-4280

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	06/30/2025

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