MEDICARE: JACOB POPPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	065004	NY

General Provider Information

NPI Number	:	1033672563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB POPPER

Provider Business Mailing Address
First Line	:	485 ARLINGTON RD
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1236
Country	:	US
Telephone Number	:	215-806-3519
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 GLEN COVE RD STE 206
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1730
Country	:	US
Telephone Number	:	516-621-2323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	09/15/2025

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Directions to “ JACOB POPPER ” Practice Location

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