Healthcare Provider Details

I. General information

NPI: 1710166137
Provider Name (Legal Business Name): JONATHAN HILL KOPCHICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

IV. Provider business mailing address

26 HEMENWAY ST APT 6
BOSTON MA
02115-2949
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6298
  • Fax:
Mailing address:
  • Phone: 616-560-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN266818
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: