Healthcare Provider Details

I. General information

NPI: 1568454577
Provider Name (Legal Business Name): HEATHER S KOPFF D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PALISADES DR SUITE 100
ALBANY NY
12205-1443
US

IV. Provider business mailing address

4 PALISADES DR SUITE 100
ALBANY NY
12205-1443
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-9545
  • Fax: 518-446-9551
Mailing address:
  • Phone: 518-446-9545
  • Fax: 518-446-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number205348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: