MEDICARE: KOPIDAKIS & KOPIDAKIS PTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1184626186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOPIDAKIS & KOPIDAKIS PTR

Provider Business Mailing Address
First Line	:	98 JAMES ST
Second Line	:	SUITE 101
City	:	EDISON
State	:	NJ
Zip	:	08820-3902
Country	:	US
Telephone Number	:	732-548-8980
Fax Number	:	732-548-6652

Provider Business Practice Location Address
First Line	:	98 JAMES ST
Second Line	:	SUITE 101
City	:	EDISON
State	:	NJ
Zip	:	08820-3902
Country	:	US
Telephone Number	:	732-548-8980
Fax Number	:	732-548-6652

Authorized Official
Title or Position	:	MANAGING PHYSICIAN
Name	:	DR. GEORGE E KOPIDAKIS
Credential	:	MD
Telephone Number	:	732-548-8980

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/22/2020

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