Provider Demographics
NPI:1891976197
Name:ANNA V. KOPEC, MD
Entity Type:Organization
Organization Name:ANNA V. KOPEC, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:KOPEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-858-4300
Mailing Address - Street 1:730 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1838
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:07002-1838
Practice Address - Country:US
Practice Address - Phone:201-858-4300
Practice Address - Fax:201-339-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07155800207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043614Medicare PIN