Healthcare Provider Details

I. General information

NPI: 1891976197
Provider Name (Legal Business Name): ANNA V. KOPEC, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 KENNEDY BLVD
BAYONNE NJ
07002-1838
US

IV. Provider business mailing address

730 KENNEDY BLVD
BAYONNE NJ
07002-1838
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-4300
  • Fax: 201-339-0708
Mailing address:
  • Phone: 201-858-4300
  • Fax: 201-339-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number25MA07155800
License Number StateNJ

VIII. Authorized Official

Name: DR. ANNA VERONICA KOPEC
Title or Position: DOCTOR
Credential: MD
Phone: 201-858-4300