Healthcare Provider Details

I. General information

NPI: 1205944709
Provider Name (Legal Business Name): KENNETH J. KOPACZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SO. ORANGE AVE SUITE 180 ANNEX
LIVINGSTON NJ
07039
US

IV. Provider business mailing address

200 SO. ORANGE AVE SUITE 180 ANNEX
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 973-226-2725
  • Fax: 973-226-3270
Mailing address:
  • Phone: 973-226-2725
  • Fax: 973-226-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA05400200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA05400200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: