Provider Demographics
NPI:1942346820
Name:COPLAN, BETH FAYE (RD)
Entity Type:Individual
Prefix:MISS
First Name:BETH
Middle Name:FAYE
Last Name:COPLAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 LEXINGTON BLVD
Mailing Address - Street 2:#26
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066
Mailing Address - Country:US
Mailing Address - Phone:732-382-5213
Mailing Address - Fax:
Practice Address - Street 1:166 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112
Practice Address - Country:US
Practice Address - Phone:973-926-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ929433133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11582647OtherCOUNCIL OF AFFORDABLE QUA
NJ3966760HMOOtherAETNA US HEALTHCARE
NJP3595973OtherOXFORD HEALTH PLAN
NJLETFXD051806OtherGREAT WEST ONE HEALTH PLA
NJPHONE051806OtherUNITED HEALTHCARE
NJ11582647OtherCOUNCIL OF AFFORDABLE QUA