Provider Demographics
NPI:1477644599
Name:KOPEC, ANNA VERONICA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VERONICA
Last Name:KOPEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:V
Other - Last Name:SHAKALIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:730 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-858-4300
Mailing Address - Fax:201-339-0708
Practice Address - Street 1:730 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-858-4300
Practice Address - Fax:201-339-0708
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03213900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
K0431121Medicare ID - Type Unspecified
C54271Medicare UPIN