Healthcare Provider Details

I. General information

NPI: 1689648016
Provider Name (Legal Business Name): ERIC HOPPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

270 PARK AVE
HUNTINGTON NY
11743-2787
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9200
  • Fax:
Mailing address:
  • Phone: 631-547-6392
  • Fax: 631-351-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number43293
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228091
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: