Healthcare Provider Details

I. General information

NPI: 1528025434
Provider Name (Legal Business Name): JANE ANN KOOP ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MAIN ST SUITE 110
BABYLON NY
11702-3027
US

IV. Provider business mailing address

272 JOHNSON AVE
SAYVILLE NY
11782-1144
US

V. Phone/Fax

Practice location:
  • Phone: 631-669-4500
  • Fax: 631-669-7710
Mailing address:
  • Phone: 631-589-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number303829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: