{
"Npi": {
"NPI": "1740577964",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KEVIN NORMAN KOPACK",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "297 PASSAIC AVE STE 3",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRFIELD",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07004-2548",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-227-4280",
"MailingAddressFaxNumber": "973-227-4210",
"FirstLinePracticeLocationAddress": "297 PASSAIC AVE",
"SecondLinePracticeLocationAddress": "UNIT 3",
"PracticeLocationAddressCityName": "FAIRFIELD",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07004-2503",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-227-4280",
"PracticeLocationAddressFaxNumber": "973-227-4210",
"EnumerationDate": "07/08/2011",
"LastUpdateDate": "06/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOPACK",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": "NORMAN",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "973-227-4280",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "40QAO0335300",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}