Healthcare Provider Details

I. General information

NPI: 1558543876
Provider Name (Legal Business Name): MAGDALINE S KOPACZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WILLOW AVE
HOBOKEN NJ
07030-3808
US

IV. Provider business mailing address

19 MOHAWK AVE
NORWOOD NJ
07648-2410
US

V. Phone/Fax

Practice location:
  • Phone: 781-588-7878
  • Fax:
Mailing address:
  • Phone: 781-588-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08132600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: