Healthcare Provider Details

I. General information

NPI: 1629085303
Provider Name (Legal Business Name): LOIS J COPELAND MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CENTRAL AVE
HILLSDALE NJ
07642-2118
US

IV. Provider business mailing address

47 CENTRAL AVE
HILLSDALE NJ
07642-2118
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-1212
  • Fax: 201-666-7433
Mailing address:
  • Phone: 201-664-1212
  • Fax: 201-666-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MA02859300
License Number StateNJ

VIII. Authorized Official

Name: DR. LOIS JACQUELINE COPELAND
Title or Position: PRESIDENT
Credential: MD
Phone: 201-664-1212