Provider Demographics
NPI:1114241387
Name:KOPYLENKO DPM PC
Entity Type:Organization
Organization Name:KOPYLENKO DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZINAIDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOPYLENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:347-645-3044
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 1:4 BRIDGE PLAZA DR STE 6
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:732-823-8769
Practice Address - Fax:732-444-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00292700213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty