Healthcare Provider Details

I. General information

NPI: 1124295407
Provider Name (Legal Business Name): ZINAIDA V KOPYLENKO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 MARC DR
NORTH BRUNSWICK NJ
08902-5104
US

IV. Provider business mailing address

224 MARC DR
NORTH BRUNSWICK NJ
08902-5104
US

V. Phone/Fax

Practice location:
  • Phone: 347-645-3044
  • Fax:
Mailing address:
  • Phone: 347-645-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00292700
License Number StateNJ

VIII. Authorized Official

Name: DR. ZINAIDA V KOPYLENKO
Title or Position: PODIATRIST
Credential: D.P.M
Phone: 347-645-3044