Provider Demographics
NPI:1437790698
Name:KOPFENSTEINER, COURTNEY (PA-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:KOPFENSTEINER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E RIDGEWOOD AVE STE 630N
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3917
Mailing Address - Country:US
Mailing Address - Phone:201-447-8018
Mailing Address - Fax:201-389-0533
Practice Address - Street 1:140 E RIDGEWOOD AVE STE 630N
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3917
Practice Address - Country:US
Practice Address - Phone:201-447-8018
Practice Address - Fax:201-389-0533
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00828700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024082OtherNYS LICENSE