Healthcare Provider Details

I. General information

NPI: 1508241456
Provider Name (Legal Business Name): ALEKSANDR KOPACH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

2520 BATCHELDER ST SPT 3C
BROOKLYN NY
11235-1553
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9000
  • Fax:
Mailing address:
  • Phone: 718-427-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: