Individual
NICOLE DOLORES KOPCHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
535 W 110TH ST APT 1E, NEW YORK, NY 10025-2021
(212) 280-4740
Mailing address
1211 GANNET CT, FORKED RIVER, NJ 08731-5533
(908) 770-1146
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
026978
NY
Other
Enumeration date
05/07/2021
Last updated
09/15/2022
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