Healthcare Provider Details

I. General information

NPI: 1134463193
Provider Name (Legal Business Name): KEVIN S. LOPYAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 HIGHWAY 35 SUITE 106
EATONTOWN NJ
07724-1876
US

IV. Provider business mailing address

142 HIGHWAY 35 SUITE 106
EATONTOWN NJ
07724-1876
US

V. Phone/Fax

Practice location:
  • Phone: 732-935-9393
  • Fax: 732-935-0101
Mailing address:
  • Phone: 732-935-9393
  • Fax: 732-935-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN S LOPYAN
Title or Position: OWNER
Credential: MD
Phone: 732-935-9393