Healthcare Provider Details

I. General information

NPI: 1023140100
Provider Name (Legal Business Name): NICHOLAS KOTOPOULOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ENGLE ST
ENGLEWOOD NJ
07631-2905
US

IV. Provider business mailing address

40 ENGLE ST
ENGLEWOOD NJ
07631-2905
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-0522
  • Fax: 201-567-5955
Mailing address:
  • Phone: 201-568-0522
  • Fax: 201-567-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA03676200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: