Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 25MA05400200 | NJ |
N | 207XS0117X | Orthopaedic Spine Surgeon | MA054002 | NJ |
NPI | 1205944709 |
---|---|
Provider Name | Mr. Kenneth J. Kopacz |
First Address | Livingston, NJ 07039 |
Second Address | Livingston, NJ 07039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 08/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E88019 | (02) | |
E88019 | (02) | NJ |
ES546 | OXFORD (01) | |
F12538 | HEALTHNET (01) |