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General NPI Number Information
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NPI Number | 1790043800
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Entity Type | Individual
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Provider Name | JUSTIN JAMES KOPA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 175 REMSEN ST FL 7
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City | BROOKLYN
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State | NY
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Zip | 11201-4333
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Country | US
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Telephone | 929-697-2947
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Fax | 718-690-3934
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Provider Business Mailing Address
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Address Line | 117 W 124TH ST FL 6
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City | NEW YORK
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State | NY
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Zip | 10027-4920
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Country | US
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Telephone | 929-697-2947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 279148
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License Number State | NY
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