Healthcare Provider Details

I. General information

NPI: 1205804358
Provider Name (Legal Business Name): LIZABETH A KOPP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 607
HACKENSACK NJ
07601
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 607
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-3464
  • Fax: 201-487-0232
Mailing address:
  • Phone: 201-487-3464
  • Fax: 201-487-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA54619
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5710264
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGHI PPO#
# 2
Identifier0511933
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA HMO#
# 3
IdentifierP00136767
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerRAILROAD MEDICARE#
# 4
Identifier4290039
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA PPO#
# 5
Identifier50Z741
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS#
# 6
IdentifierBP399
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD#
# 7
Identifier0K2421
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerHEALTHNET#

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: