Healthcare Provider Details

I. General information

NPI: 1922286871
Provider Name (Legal Business Name): NEIL J KOPPEL DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2008
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 LAKEVILLE RD SUITE 203
LAKE SUCCESS NY
11042-1165
US

IV. Provider business mailing address

4500 EXECUTIVE DR SUITE 330
NAPLES FL
34119-8939
US

V. Phone/Fax

Practice location:
  • Phone: 516-504-4040
  • Fax: 516-482-1948
Mailing address:
  • Phone: 239-214-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008178
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002077
License Number StateNY

VIII. Authorized Official

Name: DR. NEIL J KOPPEL
Title or Position: OWNER
Credential: DC LAC
Phone: 516-504-4040