Healthcare Provider Details

I. General information

NPI: 1083609069
Provider Name (Legal Business Name): NILES CHOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

400 NEW HAMPSHIRE AVE
LAKEWOOD NJ
08701-4509
US

IV. Provider business mailing address

400 NEW HAMPSHIRE AVE
LAKEWOOD NJ
08701-4509
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-1290
  • Fax: 732-905-8649
Mailing address:
  • Phone: 732-364-1290
  • Fax: 732-905-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA065067
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: