Provider Demographics
NPI:1043287741
Name:BOPP, LORRAINE CATHERINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:CATHERINE
Last Name:BOPP
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEAVERSON BLVD
Mailing Address - Street 2:STE 1A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-477-0441
Mailing Address - Fax:732-477-9057
Practice Address - Street 1:35 BEAVERSON BLVD
Practice Address - Street 2:STE 1A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-477-0441
Practice Address - Fax:732-477-9057
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00202400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ673306XTEMedicare PIN
U17872Medicare UPIN