Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 25MD00292700 | NJ |
N | 213ES0131X | Foot Surgery | N006210-1 | NY |
NPI | 1083810717 |
---|---|
Provider Name | Dr. Zinaida Viktoria Kopylenko |
First Address | Manalapan, NJ 07726-2948 |
Second Address | Manalapan, NJ 07726-1700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02967628 | (05) | NY |
P11071 | NY MEDICARE (01) | NY |