Healthcare Provider Details

I. General information

NPI: 1497993646
Provider Name (Legal Business Name): BLUE SKY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 LACEY RD SUITE 5
WHITING NJ
08759-2912
US

IV. Provider business mailing address

67 LACEY RD SUITE 5
WHITING NJ
08759-2912
US

V. Phone/Fax

Practice location:
  • Phone: 732-849-0707
  • Fax: 732-849-0016
Mailing address:
  • Phone: 732-849-0707
  • Fax: 732-849-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number25MA06506800
License Number StateNJ

VIII. Authorized Official

Name: DR. JOAN Z CHOPER
Title or Position: M.D.
Credential:
Phone: 732-849-0707