Provider Demographics
NPI:1679573307
Name:KOPELAN, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:KOPELAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MILLBURN AVE
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1737
Mailing Address - Country:US
Mailing Address - Phone:973-379-5888
Mailing Address - Fax:973-912-9757
Practice Address - Street 1:225 MILLBURN AVE
Practice Address - Street 2:SUITE 104B
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1737
Practice Address - Country:US
Practice Address - Phone:973-379-5888
Practice Address - Fax:973-912-9757
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07605700208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7943610OtherAETNA PPO #
NJ3630367OtherAETNA HMO #
NJ0052281Medicaid
NJ8221580OtherGHI PPO #
NJ2K8702OtherHEALTHNET #
NJ2417571000OtherAMERIHEALTH #
NJP00123010OtherRAILROAD MDCR #
NJ3630367OtherAETNA HMO #
NJP00123010OtherRAILROAD MDCR #