Healthcare Provider Details

I. General information

NPI: 1871687012
Provider Name (Legal Business Name): DAVID L. KOPLON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 DOVER TER
MONSEY NY
10952-2107
US

IV. Provider business mailing address

26 DOVER TER
MONSEY NY
10952-2107
US

V. Phone/Fax

Practice location:
  • Phone: 845-356-2148
  • Fax: 845-356-3685
Mailing address:
  • Phone: 845-356-2148
  • Fax: 845-356-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: