Provider Demographics
NPI:1659916054
Name:KOPSCO, DAVID CLARK (NP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLARK
Last Name:KOPSCO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 SPRINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-1229
Mailing Address - Country:US
Mailing Address - Phone:609-462-8676
Mailing Address - Fax:
Practice Address - Street 1:23659 COLUMBUS RD STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1980
Practice Address - Country:US
Practice Address - Phone:609-298-3304
Practice Address - Fax:609-298-7091
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00982500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily