Provider Demographics
NPI:1164520862
Name:ZOPPI, JEANNINE
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:ZOPPI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 ROSELAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 ROSELAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5965
Practice Address - Country:US
Practice Address - Phone:973-886-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00381800103TC0700X
NY013715-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ234800OtherMHN/GUARDIAN HEALTHNET
NJ262536OtherCOMPSYCH
NJ8354201Medicaid
NJ9414832OtherPRIVATE HEALTHCARE SYSTEM
NJP2133003OtherOXFORD PROVIDER NUMBER
NYP2357034OtherOXFORD PROVIDER NUMBER
NY02120405Medicaid
NJ7657355OtherAETNA
NJ7657355OtherAETNA
NYVL3251Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER