Provider Demographics
NPI:1699077909
Name:KOPP MULBERG, FERN ELYSE (DO)
Entity type:Individual
Prefix:DR
First Name:FERN
Middle Name:ELYSE
Last Name:KOPP MULBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:379 CAMPUS DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1161
Mailing Address - Country:US
Mailing Address - Phone:732-937-8939
Mailing Address - Fax:732-418-8372
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2900
Practice Address - Fax:732-463-5512
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008386L207Q00000X
MDH0076671207Q00000X
NJ25MB05948700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ036196ZPCNMedicare PIN
PA180868YEBKMedicare PIN
MD325978YVZMedicare PIN
MD325978ZDDBMedicare PIN
MD180868YUNMMedicare PIN