Provider Demographics
NPI:1497993646
Name:BLUE SKY MEDICAL LLC
Entity Type:Organization
Organization Name:BLUE SKY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:CHOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-849-0707
Mailing Address - Street 1:67 LACEY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2912
Mailing Address - Country:US
Mailing Address - Phone:732-849-0707
Mailing Address - Fax:732-849-0016
Practice Address - Street 1:67 LACEY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2912
Practice Address - Country:US
Practice Address - Phone:732-849-0707
Practice Address - Fax:732-849-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06506800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA06506800OtherMEDICAL LICENSE
NJ7852509Medicaid
NJ7852509Medicaid