MEDICARE: JOHN K OPPENHEIMER M.D.

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	207R00000X	Internal Medicine Physician	150853	NY

General Provider Information

NPI Number	:	1659364214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN K OPPENHEIMER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3137
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-0405
Country	:	US
Telephone Number	:	631-725-4600
Fax Number	:	631-725-6073

Provider Business Practice Location Address
First Line	:	60 BAY ST
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-3106
Country	:	US
Telephone Number	:	631-725-4600
Fax Number	:	631-725-6073

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	08/21/2009

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