Provider Demographics
NPI:1639305311
Name:GOLDKOPF, ILENE (OTR)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:GOLDKOPF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3308
Mailing Address - Country:US
Mailing Address - Phone:732-441-0404
Mailing Address - Fax:732-441-1422
Practice Address - Street 1:92A VANDERBURG RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1433
Practice Address - Country:US
Practice Address - Phone:732-441-0404
Practice Address - Fax:732-441-1422
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00031800225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics