Provider Demographics
NPI:1083810717
Name:KOPYLENKO, ZINAIDA VIKTORIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ZINAIDA
Middle Name:VIKTORIA
Last Name:KOPYLENKO
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 1:24 FORMAN LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2948
Mailing Address - Country:US
Mailing Address - Phone:347-645-3044
Mailing Address - Fax:732-851-5566
Practice Address - Street 1:95 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1700
Practice Address - Country:US
Practice Address - Phone:732-823-8769
Practice Address - Fax:732-851-5566
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006210-1213ES0131X
NJ25MD00292700213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP11071OtherNY MEDICARE
NY02967628Medicaid