Provider Demographics
NPI:1205944709
Name:KOPACZ, KENNETH J (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:KOPACZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SO. ORANGE AVE
Mailing Address - Street 2:SUITE 180 ANNEX
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-226-2725
Mailing Address - Fax:973-226-3270
Practice Address - Street 1:200 SO. ORANGE AVE
Practice Address - Street 2:SUITE 180 ANNEX
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-226-2725
Practice Address - Fax:973-226-3270
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA054002207XS0117X
NJ25MA05400200207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ES546OtherOXFORD
F12538OtherHEALTHNET
E88019Medicare UPIN
ES546OtherOXFORD
F12538OtherHEALTHNET