Healthcare Provider Details

I. General information

NPI: 1336537000
Provider Name (Legal Business Name): MAUREEN KOPROWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 BROADHOLLOW RD
MELVILLE NY
11747-3676
US

IV. Provider business mailing address

17 ROOSEVELT BLVD
EAST PATCHOGUE NY
11772-5930
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-7780
  • Fax:
Mailing address:
  • Phone: 631-714-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: