Healthcare Provider Details

I. General information

NPI: 1346358918
Provider Name (Legal Business Name): ELZBIETA KOPACZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6548 GRAND AVENUE
MASPETH NY
11378
US

IV. Provider business mailing address

6548 GRAND AVENUE
MASPETH NY
11378
US

V. Phone/Fax

Practice location:
  • Phone: 718-326-8982
  • Fax: 718-326-8983
Mailing address:
  • Phone: 718-326-8982
  • Fax: 718-326-8983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number047170NY
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: