Provider Demographics
NPI:1598267940
Name:COPESTICK, ADAM TODD (RNFA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TODD
Last Name:COPESTICK
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-0249
Mailing Address - Country:US
Mailing Address - Phone:908-867-7561
Mailing Address - Fax:
Practice Address - Street 1:4 SPARROW LN
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3567
Practice Address - Country:US
Practice Address - Phone:973-936-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14717800163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant