1568413300 NPI number — DR. BRIAN H KOPELL MD

Table of content: DR. BRIAN H KOPELL MD (NPI 1568413300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568413300 NPI number — DR. BRIAN H KOPELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPELL
Provider First Name:
BRIAN
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568413300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE GUSTAVE L. LEVY PLACE, BOX 1136
Provider Second Line Business Mailing Address:
MOUNT SINAI HOSPITAL
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029-6574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-241-0050
Provider Business Mailing Address Fax Number:
212-410-0603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 EAST 98 STREET
Provider Second Line Business Practice Location Address:
NEUROSURGERY FACULTY ASSOCIATES
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-0050
Provider Business Practice Location Address Fax Number:
212-410-0603
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  47197 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34560900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: A400067904 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 029906261P . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03441072 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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