Provider Demographics
NPI:1427166248
Name:KOPANJA, JASMINKA (MD)
Entity type:Individual
Prefix:MRS
First Name:JASMINKA
Middle Name:
Last Name:KOPANJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 PARKWAY AVE
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2704
Mailing Address - Country:US
Mailing Address - Phone:609-771-0032
Mailing Address - Fax:609-771-6028
Practice Address - Street 1:795 PARKWAY AVE
Practice Address - Street 2:SUITE A-5
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2704
Practice Address - Country:US
Practice Address - Phone:609-771-0032
Practice Address - Fax:609-771-6028
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021556001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60016094OtherHORIZON NJ HEALTH