Healthcare Provider Details

I. General information

NPI: 1659916054
Provider Name (Legal Business Name): DAVID CLARK KOPSCO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2019
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23659 COLUMBUS RD STE 4
COLUMBUS NJ
08022-1980
US

IV. Provider business mailing address

353 SPRINGDALE AVE
HAMILTON NJ
08620-1229
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-3304
  • Fax: 609-298-7091
Mailing address:
  • Phone: 609-462-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00982500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: