1851363055 NPI number — JEFF D KOPELMAN

Table of content: JEFF D KOPELMAN (NPI 1851363055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851363055 NPI number — JEFF D KOPELMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPELMAN
Provider First Name:
JEFF
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1851363055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
371 MERRICK RD
Provider Second Line Business Mailing Address:
STE 204
Provider Business Mailing Address City Name:
ROCKVILLE CTRE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-536-4444
Provider Business Mailing Address Fax Number:
516-536-4486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
371 MERRICK RD
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
ROCKVILLE CTRE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-536-4444
Provider Business Practice Location Address Fax Number:
516-536-4486
Provider Enumeration Date:
02/02/2006

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: 207YX0007X , with the licence number:  162483 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0059669 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113616761 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113616761 . This is a "MAGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113616761 . This is a "MULTEP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4231401 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS626 . This is a "OXF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22597 . This is a "VTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3C1114 . This is a "HLTHNT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113616761 . This is a "ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9347407002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28679P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1308635 . This is a "FRT HLTH" identifier . This identifiers is of the category "OTHER".




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