Healthcare Provider Details

I. General information

NPI: 1689676660
Provider Name (Legal Business Name): PAUL M. KOPFER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 TRANSIT RD
EAST AMHERST NY
14051-2124
US

IV. Provider business mailing address

9750 TRANSIT RD
EAST AMHERST NY
14051-2124
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-1375
  • Fax: 716-636-4501
Mailing address:
  • Phone: 716-636-1375
  • Fax: 716-636-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: