Provider Demographics
NPI:1417915422
Name:KOPELAN, LEAH MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MICHELLE
Last Name:KOPELAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:MICHELLE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:55 MADISON AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-993-9536
Mailing Address - Fax:973-998-4237
Practice Address - Street 1:55 MADISON AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-993-9536
Practice Address - Fax:973-998-4237
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA080051207R00000X
NJ25MA08005100208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine