Individual
KERRI LYNN KOPCZUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
50 CRAIG RD, MONTVALE, NJ 07645-1709
(888) 636-7840
(267) 479-1321
Mailing address
833 CHESTNUT ST STE 520, PHILADELPHIA, PA 19107-4430
(609) 677-7003
(267) 339-3761
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
014031
NY
363AS0400X
Surgical Physician Assistant
Primary
014031
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03280100
—
NY
Enumeration date
07/13/2010
Last updated
06/08/2022
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