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NPI Code Detail

MEDICARE: HARVEY JAY POPOLOW

MEDICARE:   HARVEY JAY POPOLOW
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
1174400000XSpecialist406479031NY

General Provider Information

NPI Number : 1265794119
Entity Type Code : Individual
Provider Name (Legal Business Name) : HARVEY JAY POPOLOW
Provider Business Mailing Address
First Line : 26009 UNION TPKE
Second Line :
City : GLEN OAKS
State : NY
Zip : 11004-1345
Country : US
Telephone Number : 516-395-5584
Fax Number :
Provider Business Practice Location Address
First Line : 26009 UNION TPKE
Second Line :
City : GLEN OAKS
State : NY
Zip : 11004-1345
Country : US
Telephone Number : 516-395-5584
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2012
Last Update Date : 06/15/2012

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Directions to “ HARVEY JAY POPOLOW ” Practice Location

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