Healthcare Provider Details

I. General information

NPI: 1437790698
Provider Name (Legal Business Name): COURTNEY KOPFENSTEINER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E RIDGEWOOD AVE STE 630N
PARAMUS NJ
07652-3917
US

IV. Provider business mailing address

140 E RIDGEWOOD AVE STE 630N
PARAMUS NJ
07652-3917
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8018
  • Fax: 201-389-0533
Mailing address:
  • Phone: 201-447-8018
  • Fax: 201-389-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00828700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: