Provider Demographics
NPI:1205804358
Name:KOPP, LIZABETH A (MD)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:A
Last Name:KOPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-487-3464
Mailing Address - Fax:201-487-0232
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-487-3464
Practice Address - Fax:201-487-0232
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5710264OtherGHI PPO#
NJ0511933OtherAETNA HMO#
NJP00136767OtherRAILROAD MEDICARE#
NJ4290039OtherAETNA PPO#
NJ50Z741OtherEMPIRE BCBS#
NJBP399OtherOXFORD#
NJ0K2421OtherHEALTHNET#
NJBP399OtherOXFORD#
NJ0K2421OtherHEALTHNET#